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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 019200273
Report Date: 02/07/2022
Date Signed: 02/07/2022 03:52:03 PM

Document Has Been Signed on 02/07/2022 03:52 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: 7DATE:
02/07/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
10:35 AM
MET WITH:Jasmine Williams, Program Director for CVS Tri-ValleyTIME COMPLETED:
04:15 PM
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On 2/7/2022 at 10:35 AM, Licensing Program Analyst (LPA) L. Ibo conducted case management visit for Cole vocational services Alameda county BMP 019200273 and met with Jasmine Williams, Program director for Cole vocational services – Tri Valley. LPA called Program Director for Cole Vocational services Alameda BMP Marina Knowles, according to Marina she is not available and gave permission to LPA to discuss and give copy or report to Jasmine Williams. LPA conducted facility tour when LPA found out that Cole vocational services - TRI-VALLEY 019200898 is using the facility premises without informing CCL Oakland Regional office.

LPA interviewed staff present during the visit (S1-S9) , according to staff interviewed there is another program that is in operation since June of 2019, and they have been using the Gym part of the facility, per facility sketch. Cole vocational services Tri-Valley no longer have their own building. Based on records review the application for Cole Vocational services Tri-Valley was withdrawn on August 6, 2019. Cole Vocational Tri-Valley do not have any license to operate.

Deficiencies are cited from Title 22 California Code of Regulations (see 809D). Failure to submit proof of corrections by plan of correction due dates, and any repeat violations within 12-month period may result in civil penalties.

Deficiencies and plan and proof of corrections were discussed with Jasmine Williams.

Exit interview conducted and a copy of this report provided. A copy of appeal rights was provided.
SUPERVISORS NAME: Harpreet Humpal
LICENSING EVALUATOR NAME: Leslie Ibo
LICENSING EVALUATOR SIGNATURE: DATE: 02/07/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/07/2022
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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Document Has Been Signed on 02/07/2022 03:52 PM - It Cannot Be Edited


Created By: Leslie Ibo On 02/07/2022 at 03:07 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: 02/07/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
02/09/2022
Section Cited
CCR
82022(g)

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Any changes in the plan of operation which affect the services to clients shall be subject to licensing agency approval and shall be reported as specified in Section 82061, Reporting Requirements

This requirement is not met as evidenced by:
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Submit updated plan of operations. If facility plan to include the clients from cole vocational services Tri-Valley, then a new admissions agreement and needs services plan needs to be updated, these documents are needed to be submitted to CCL by POC due date.
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Based on observation, interview and records review licensee did not comply with the section cited above, Cole vocational services Alameda BMP shared the facility premises to cole vocational services Tri-Valley without informing Oakland Regional office which poses an immediate health, safety or personal rights risk to persons in care.
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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:Harpreet Humpal
LICENSING EVALUATOR NAME:Leslie Ibo
LICENSING EVALUATOR SIGNATURE:
DATE: 02/07/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/07/2022


LIC809 (FAS) - (06/04)
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