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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 019200273
Report Date: 09/11/2024
Date Signed: 09/11/2024 01:35:58 PM

Document Has Been Signed on 09/11/2024 01:35 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/
DIRECTOR:		HAILU, LUFACILITY TYPE:
775
ADDRESS:1479 SALMON WAYTELEPHONE:
(510) 429-1919
CITY:HAYWARDSTATE: CAZIP CODE:
94544
CAPACITY: 45CENSUS: 5DATE:
09/11/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
11:25 AM
MET WITH:Jasmine Williams, Area DirectorTIME VISIT/
INSPECTION COMPLETED:
01:45 PM
NARRATIVE
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Licensing Program Analyst, (LPA) K. Nguyen arrived unannounced to conduct a required annual inspection on September 11, 2024, at 11:25 AM and met with Jasmine Williams, Area Director. Toured all but limited to activity rooms, quiet room, kitchen, computer room, and outdoors. Facility clean and in good repair and in conformity with Fire Marshall Regulations. Fire extinguishers serviced on 10/4/2024. Water temperature 118.9 degrees. Indoor and outdoor exits free of obstruction. This facility is licensed for 45 non-ambulatory clients.

LPA reviewed 5 client and 3 staff files. Clients have medical assessments, admission agreements, and updated needs and services plans. Staff have updated CPR/First Aid and yearly training hours. There are 6 vans available and maintained in safe operating condition.

Area Director stated that the program do not keep clients medications, and no client are on oxygen. Clients bring their own lunches and facility provides snacks. Emergency supplies, including water were observed. LPA observed there are no clients at the program, due to the daily community outing.

Deficiency observed:

-LPA observed clients IPP is not update over a year.

The deficiencies were observed (see LIC 809D) and cited from the California Code of Regulations. Failure to correct deficiencies by POC date may result in additional Civil Penalties.

Exit interview conducted. A copy of this report and appeal rights provided.
SUPERVISORS NAME: Bennett Fong
LICENSING EVALUATOR NAME: Kelly Nguyen
LICENSING EVALUATOR SIGNATURE: DATE: 09/11/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/11/2024
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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Document Has Been Signed on 09/11/2024 01:35 PM - It Cannot Be Edited


Created By: Kelly Nguyen On 09/11/2024 at 01:11 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 1515 CLAY STREET, STE. 310
OAKLAND, CA 94612

FACILITY NAME: COLE VOCATIONAL SERVICES ALAMEDA COUNTY BMP
FACILITY NUMBER: 019200273

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/11/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
82068.2(d)(1)
Needs and Services Plan
(d) If the client has an existing needs appraisal or individual program plan (IPP) completed by a placement agency, or a consultant for the placement agency, the Department may consider the plan to meet the requirements of this section provided that: (1) The needs appraisal or IPP is not more than one year old.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review the licensee did not comply with the section cited above by not having clients IPP up to date and over one year old, which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 09/30/2024
Plan of Correction
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Area Director agree to have all clients IPP updated by POC date. Area Director agree to send confirmation to CCLD of updated IPP for clients.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Bennett Fong
LICENSING EVALUATOR NAME:Kelly Nguyen
LICENSING EVALUATOR SIGNATURE:
DATE: 09/11/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/11/2024


LIC809 (FAS) - (06/04)
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