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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 019200309
Report Date: 12/27/2024
Date Signed: 01/15/2025 10:51:21 AM

Document Has Been Signed on 01/15/2025 10:51 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:GLENN VIEWFACILITY NUMBER:
019200309
ADMINISTRATOR/
DIRECTOR:		KRISTABELLE ALATASFACILITY TYPE:
735
ADDRESS:38524 GLENVIEW DRIVETELEPHONE:
(510) 894-1971
CITY:FREMONTSTATE: CAZIP CODE:
94536
CAPACITY: 3CENSUS: 0DATE:
12/27/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:00 AM
MET WITH:Josephine AbellaTIME VISIT/
INSPECTION COMPLETED:
11:00 AM
NARRATIVE
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On 01/15/2025, at 9:00 AM, Licensing Program Analysts (LPAs) P.Manalo and L. Fontanilla arrived unannounced to conduct 1-Year Annual Required inspection. LPAs met with a house guest who opened door, and explained the purpose of the visit. The Licensee, Yolanda, informed LPAs that the facility has guests staying. Care Staff, Josephine Abella, came shortly after. The licensee stated that there are no residents for over 3 years and that they want to change the facility license to RCFE. The facility’s fire clearance was approved for 3 non-ambulatory.

LPAs toured facility including but not limited to bedrooms, bathrooms, kitchen, common area and backyard. The facility consists of 5 total bedrooms and 3 bathrooms. All outdoor and indoor passageways are kept free of obstruction. There are no bodies of water observed. LPAs observed lighting in all rooms are adequate for the comfort and safety of potential residents. The hot water temperature was measured at 106 degrees Fahrenheit. All toilets, hand washing and bathing are safe, sanitary and in operating condition.

Smoke detectors were in operating condition during visit. Fire extinguisher was last serviced on 2/20/2024.
Carbon monoxide was observed not operational.

LPAs informed Licensee to notify CCLD if they start taking clients so that another inspection can be conducted.

There are no staff or client files for review.

The following deficiencies were observed (see LIC 809D) and cited from the California Code of Regulations, Title 22 and/or Health and Safety Code Failure to correct deficiencies by POC date may result in additional Civil Penalties.

Exit interview conducted with Administrator and/ or anyone who meet with. Appeal Rights and a copy of this report provided.
SUPERVISORS NAME: Yvonne Flores-Larios
LICENSING EVALUATOR NAME: Patricia Manalo
LICENSING EVALUATOR SIGNATURE: DATE: 12/27/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/27/2024
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 01/15/2025 10:51 AM - It Cannot Be Edited


Created By: Patricia Manalo On 01/15/2025 at 10:23 AM
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: GLENN VIEW
FACILITY NUMBER: 019200309

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/27/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
80087(a)
Building and Grounds
(a) The facility shall be clean, safe, sanitary and in good repair at all times for the safety and well-being of clients, employees and visitors.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, the licensee did not comply with the section cited above by needing repair in Bedroom 1, Bedroom 2, and Staff room 2 window and screen door and tree branches piled up in the backyard which poses a potential health and safety risks to person in care.
POC Due Date: 01/23/2025
Plan of Correction
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The licensee agrees to repair the window and screen door, remove the tree branches, and send proof to CCLD by POC date.
Type B
Section Cited
CCR
80022(k)
(k)The facility shall operate in accordance with the terms specified in the Plan of Operation and may be cited for not doing so.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation the licensee did not comply with the section cited above in having two guests stay at the facility which poses a potential health and safety risk to persons in care.
POC Due Date: 01/17/2025
Plan of Correction
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The licensee states one guest will be working for one of her facilities (Burnham Place) and the other guest is leaving town tomorrow. Self-certification will be sent to CCL by POC date.
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:Yvonne Flores-Larios
LICENSING EVALUATOR NAME:Patricia Manalo
LICENSING EVALUATOR SIGNATURE:
DATE: 01/15/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/15/2025


LIC809 (FAS) - (06/04)
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