<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 019200506
Report Date: 01/29/2025
Date Signed: 01/29/2025 10:04:34 AM

Document Has Been Signed on 01/29/2025 10:04 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:HERITAGE HAVENFACILITY NUMBER:
019200506
ADMINISTRATOR/
DIRECTOR:		FERDINAND GUTIERREZFACILITY TYPE:
740
ADDRESS:389 JUANA AVENUETELEPHONE:
(510) 357-1300
CITY:SAN LEANDROSTATE: CAZIP CODE:
94577
CAPACITY: 27CENSUS: 22DATE:
01/29/2025
TYPE OF VISIT:POCUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
07:30 AM
MET WITH:Ferdinand Gutierrez, AdministratorTIME VISIT/
INSPECTION COMPLETED:
10:00 AM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
On 1/29/2025 at 7:30 AM, Licensing Program Analyst (LPA) James Sampair arrived unannounced to conduct a Plan of Correction (POC) visit. Upon arrival, LPA stated the purpose of the visit to Caregiver Laila Deguzman. Administrator Ferdinand Gutierrez joined the LPA at approximately 8:45 AM.

The LPA toured the facility inside and outside with the Caregiver and the Administrator. The LPA observed that the smoke detectors have been installed and functioning, but the physical plant remains in disrepair. The LPA and Administrator spoke with the Licensee Jene Snipe over the phone who stated that the work on the physical plant has again been delayed because the distribution of the money they are receiving from Alameda County to pay for the repairs will not be available until March of 2025.

No citations issued.

Exit interview conducted and a copy of this report provided.
SUPERVISORS NAME: Harpreet Humpal
LICENSING EVALUATOR NAME: James Sampair
LICENSING EVALUATOR SIGNATURE: DATE: 01/29/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/29/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 1