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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 019200273
Report Date: 04/15/2022
Date Signed: 04/15/2022 01:36:34 PM

Document Has Been Signed on 04/15/2022 01:36 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:COLE VOCATIONAL SERVICES ALAMEDA COUNTY BMPFACILITY NUMBER:
019200273
ADMINISTRATOR:BILLECI, MELISSA EFACILITY TYPE:
775
ADDRESS:1479 SALMON WAYTELEPHONE:
(510) 429-1919
CITY:HAYWARDSTATE: CAZIP CODE:
94544
CAPACITY: 45CENSUS: 9DATE:
04/15/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
12:35 PM
MET WITH:Shanishia Evans, Program DirectorTIME COMPLETED:
01:50 PM
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On 4/15/2022 at 12:35 PM, Licensing Program Analyst (LPA) C. Fowler arrived unannounced to conduct 1-Year Annual Infection Control Inspection. LPA met with Program Director, Shanishia Evans and explained the purpose of the visit. Day program operates from 9:00 AM to 3:00 PM. There were 4 staff observed and 9 clients here today.

LPA toured facility with Shanishia Evans, Program Director, including but not limited to, multiple activity rooms, kitchen, bathrooms, office space. Clients bring their own lunches and facility provides snacks. Emergency supplies, including water were observed. The hot water temperature in the client bathroom measured 112.6 degrees Fahrenheit. Cleaning supplies are locked and inaccessible to clients. Medications are not handled/dispensed by the program at this time. There are no bodies of water or fire safety hazards observed. Restrooms are maintained in safe and in sanitary operating condition.

No deficiencies cited during visit.

Exit interview conducted and a copy of this report provided.

SUPERVISORS NAME: Bennett Fong
LICENSING EVALUATOR NAME: Carol Fowler
LICENSING EVALUATOR SIGNATURE: DATE: 04/15/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/15/2022
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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