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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 019200309
Report Date: 09/23/2022
Date Signed: 09/23/2022 10:18:43 AM

Document Has Been Signed on 09/23/2022 10:18 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
CCLD Regional Office, 1515 CLAY STREET, STE. 310
OAKLAND, CA 94612
FACILITY NAME:GLENN VIEWFACILITY NUMBER:
019200309
ADMINISTRATOR:KRISTABELLE ALATASFACILITY TYPE:
735
ADDRESS:38524 GLENVIEW DRIVETELEPHONE:
(510) 894-1971
CITY:FREMONTSTATE: CAZIP CODE:
94536
CAPACITY: 3CENSUS: 0DATE:
09/23/2022
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
09:15 AM
MET WITH:Josephine Abella, Administrator TIME COMPLETED:
10:05 AM
NARRATIVE
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On today’s date 9/23/2022, Licensing Program Analyst L. Fici (LPA) and Licensing Program Manager Y. Flores-Larios (LPM) arrived unannounced for the purpose of delivering complaint findings. Upon arrival at 9:15am LPA and LPM met with a person who did not identify herself at the front door and refused to let LPA and LPM in. LPA and LPM explained reason for visit and unidentified person continued to refuse entry. LPA received a call from Yolanda Alatas, Administrator (ADM) stating another reason for call. LPA advised ADM that the visitor in the facility refused to let us in to deliver investigation findings on a complaint dated back in 2020. At 9:32 AM, the unknown person stated her name Elvie Chan and let LPA and LPM in. At 9:41 AM, Josephine Abella, Administrator arrived to the facility and greeted LPA and LPM and explained the purpose of our visit.


On todays visit, facility is being assessed $500.00 for refusing entry.

Exit interview conducted with ADM, Josephine Abella and this report provided along with appeal rights.
SUPERVISORS NAME: Yvonne Flores-Larios
LICENSING EVALUATOR NAME: Liridon Fici
LICENSING EVALUATOR SIGNATURE: DATE: 09/23/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/23/2022
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 09/23/2022 10:18 AM - It Cannot Be Edited


Created By: Liridon Fici On 09/23/2022 at 10:06 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: 09/23/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
09/30/2022
Section Cited
CCR
80044(a)

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Inspection Authority of the Licensing Agency:
(a) The licensing agency shall have the inspection authority specified in Health and Safety Code Sections 1526.5, 1533, 1534, 1538, and 1538.7.
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Administrator agreed to send CCL a self-certification regarding allowing LPAs into the facility during inspection and to send to CCL by due date.

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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:Yvonne Flores-Larios
LICENSING EVALUATOR NAME:Liridon Fici
LICENSING EVALUATOR SIGNATURE:
DATE: 09/23/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/23/2022


LIC809 (FAS) - (06/04)
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