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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 019200286
Report Date: 06/15/2023
Date Signed: 06/15/2023 12:47:06 PM

Document Has Been Signed on 06/15/2023 12:47 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:GREEN OAK DEVELOPMENTAL CENTER IIFACILITY NUMBER:
019200286
ADMINISTRATOR:MARIA LEANOFACILITY TYPE:
775
ADDRESS:2827 WHIPPLE ROADTELEPHONE:
(510) 475-6069
CITY:UNION CITYSTATE: CAZIP CODE:
94587
CAPACITY: 60CENSUS: 12DATE:
06/15/2023
TYPE OF VISIT:Case Management - Health ChecksUNANNOUNCEDTIME BEGAN:
10:10 AM
MET WITH:Maria Leano, Program DirectorTIME COMPLETED:
11:00 AM
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On this day at around 10:30 am, Licensing Program Analyst (LPA) Luisa Fontanilla conducted a case management health and safety check in connection with a complaint received. LPA met with Program Director (PD) Maria Leano and explained the purpose of visit.

LPA observed 12 clients and 6 staff including PD and Assistant PD on site. PD states one staff and one client are out for a community outing. Hot water in the female bathroom measured at 114 Fahrenheit. Room temperature was at 70 Fahrenheit. LPA observed the day program to be clean and odor free. There was sufficient lighting. Clients were engaged in different activities.

There were no immediate health and safety issues observed during the visit.

A copy of this report was provided to PD.
SUPERVISORS NAME: Yvonne Flores-Larios
LICENSING EVALUATOR NAME: Luisa Fontanilla
LICENSING EVALUATOR SIGNATURE: DATE: 06/15/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/15/2023
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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