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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 019200529
Report Date: 07/10/2024
Date Signed: 07/10/2024 05:24:25 PM


Document Has Been Signed on 07/10/2024 05:24 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
E BAY DELTA AC/SC, 1515 CLAY STREET, STE. 310
OAKLAND, CA 94612



FACILITY NAME:LAKESIDE PARKFACILITY NUMBER:
019200529
ADMINISTRATOR:ESPINOZA, CHELSEA JFACILITY TYPE:
740
ADDRESS:468 PERKINS STTELEPHONE:
(510) 444-4684
CITY:OAKLANDSTATE: CAZIP CODE:
94610
CAPACITY:76CENSUS: 53DATE:
07/10/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
04:00 PM
MET WITH:Grant Haywood, Executive DirectorTIME COMPLETED:
05:30 PM
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On 07/10/2024 at 3:00 PM Licensing Program Analyst (LPA) Lori Alexander arrived unannounced to conduct a Case Management visit regarding an incident that was reported to CCLD on 07/02/2024 while conducting a complaint investigation, 15-AS-20240702150218 on 07/10/2024. LPA met with Executive Director, Grant Haywood, and explained the purpose of the visit. CCLD was notified that the facility did not have a current food director for the past 2 months.

LPA reviewed current job posting for Dining Services Director, interim food director's resume and ServSafe Food credentials. S1 stated that the former food director was terminated about 2 months ago. However, S1 stated that another qualified food director is coming to their facility as an interim until they hire another food director. S2 stated that the food director, S3, is someone that use to work at the facility but currently is the food director at their sister facility, Watermark by The Bay located in Emeryville. S2 stated that they posted the position for Dining Services Director on 04/25/24 on Indeed; hiring job platform. S2 stated that they have conducted some interviews with possible candidates but have not found the right person for the position.

No deficiencies issued during the visit.

Exit interview conducted and a copy of this report was provided.
SUPERVISOR'S NAME: Bennett FongTELEPHONE: (510) 725-7919
LICENSING EVALUATOR NAME: Lori Alexander-WashingtonTELEPHONE: (510) 285-3934
LICENSING EVALUATOR SIGNATURE:
DATE: 07/10/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/10/2024
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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