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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 019200249
Report Date: 06/17/2024
Date Signed: 06/17/2024 06:45:10 PM

Document Has Been Signed on 06/17/2024 06:45 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1515 CLAY STREET, STE. 310
OAKLAND, CA 94612
FACILITY NAME:JERLEAH'S GARDENFACILITY NUMBER:
019200249
ADMINISTRATOR/
DIRECTOR:		LEAH AQUINO-OLIVEROSFACILITY TYPE:
735
ADDRESS:360 CASWELL AVENUETELEPHONE:
(510) 969-7892
CITY:OAKLANDSTATE: CAZIP CODE:
94603
CAPACITY: 6CENSUS: 6DATE:
06/17/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
05:45 PM
MET WITH:Leah Aquino-Oliveros, AdministratorTIME VISIT/
INSPECTION COMPLETED:
07:00 PM
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LPA K. Nguyen conducted an unannounced case management visit to serve an immediate exclusion order to staff S1. LPA K. Nguyen first spoke privately with Administrator/ Licensee, Leah Aquino-Oliveros to explain the situation - providing her with a copy via email of the Order of Immediate Exclusion. According to Administrator/ Licensee S1 never came back in the facility since 2014, also confirmed S1 is not a staff at the facility since 2014.

LPA K. Nguyen reviewed this report with Administrator/ Licensee, and a copy of this report is provided via email.
SUPERVISORS NAME: Bennett Fong
LICENSING EVALUATOR NAME: Kelly Nguyen
LICENSING EVALUATOR SIGNATURE: DATE: 06/17/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/17/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
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