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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 019200529
Report Date: 05/22/2024
Date Signed: 05/22/2024 02:35:26 PM


Document Has Been Signed on 05/22/2024 02:35 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
OAKLAND ASC, 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: 52DATE:
05/22/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
01:56 PM
MET WITH:Grant Haywood, Executive DirectorTIME COMPLETED:
02:55 PM
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On 05/22/2024 while at the facility for another reason, Licensing Program Analyst (LPA) A Gomez found that staff are not trained on how to utilize the emergency evacuation chair located in the stairwell.

LPA spoke with S1 and S2 who stated that they have never been trained on utilizing the evacuation chair. S2 stated that they were not aware of what an evacuation chair was. LPA also spoke with the Executive Director who stated that they have not been trained on how to utilize the emergency evacuation chair at the facility. Staff where unable to demonstrate on how to properly utilize the chair.

LPA informed the ED of the importance of knowing how to utilize the evacuation chair in the event of an emergency and ensuring that a chair is available at each stairwell.



No deficiencies cited during visit. Exit interview conducted and a copy of this report provided.
SUPERVISOR'S NAME: Yvonne Flores-LariosTELEPHONE: (510) -28-0517
LICENSING EVALUATOR NAME: Alona GomezTELEPHONE: 510-239-1306
LICENSING EVALUATOR SIGNATURE:
DATE: 05/22/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/22/2024
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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