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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 019200286
Report Date: 01/10/2024
Date Signed: 01/10/2024 10:29:54 AM

Document Has Been Signed on 01/10/2024 10:29 AM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
OAKLAND ASC, 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: 34DATE:
01/10/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Administrator, Maria LeanoTIME COMPLETED:
10:40 AM
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Licensing Program Analyst (LPA) A. Gomez arrived unannounced to conduct a 1 Year Required inspection on this date. LPA was met by administrator, Maria Leano and explained reason for visit.

LPA inspected the facility including but not limited to the bathrooms, classrooms, and main activity room. Clients bring own lunch to the facility and LPA observed storage area for lunches. The hot water temperature in the clients bathroom measured 113.7 degrees Fahrenheit. All observed toilets and hand washing stations are maintained in a safe, sanitary, operating condition. There are no bodies of water or fire safety hazards observed. Carbon monoxide and smoke detectors are interconnected and inspected by local fire department. All staff members have a current first aid and CPR. First aid kit inspected and complete. Emergency Disaster Plan was posted and dated 12/29/2023. Last fire drill was conducted on 12/27/2023 . Fire extinguisher last serviced on 7/18/2023.

LPA reviewed three (3) staff files. All staff files reviewed contained a current first aid/CPR certification. All staff have appropriate fingerprint clearance and are associated to the facility. LPA reviewed four (4) client files. All files contain current admissions agreement, medical assessment, and service plans. LPA reviewed P&I money and log. Facility has sufficient surety bond to cover amount of cash being handled at one time.



No deficiencies were cited during this inspection. Facility appears to be in compliance with California Code of Regulations, Title 22. Exit interview conducted and a copy of report provided.
SUPERVISORS NAME: Yvonne Flores-Larios
LICENSING EVALUATOR NAME: Alona Gomez
LICENSING EVALUATOR SIGNATURE: DATE: 01/10/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/10/2024
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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