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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 019200705
Report Date: 05/16/2022
Date Signed: 05/16/2022 12:50:01 PM

Document Has Been Signed on 05/16/2022 12:50 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
CCLD Regional Office, 1515 CLAY STREET, STE. 310
OAKLAND, CA 94612
FACILITY NAME:FULTON CAREFACILITY NUMBER:
019200705
ADMINISTRATOR:OCAL, GLENFACILITY TYPE:
735
ADDRESS:29024 RUUS ROADTELEPHONE:
(510) 887-6026
CITY:HAYWARDSTATE: CAZIP CODE:
94544
CAPACITY: 14CENSUS: 11DATE:
05/16/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
12:00 PM
MET WITH:Glen Ocal, AdministratorTIME COMPLETED:
01:05 PM
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On 5/16/2022 approximately at 10:05AM, Licensing Program Analysts (LPAs) C. Lin and L. Francisco conducted case management visit while at the facility for another matter, LPAs met with Administrator, Glen Ocal and informed him the reason for visit.

During case management visit, LPAs discussed the physical plan with Administrator regarding the unlocked knives in the kitchen drawer. LPAs observed staff was at kitchen, the door to the kitchen and dinning area was remained locked. Administrator stated that the dinner area only opened at dinner time and staff was always present.

Exit interview conducted with Administrator, and copy of the report provided.
SUPERVISORS NAME: Bennett Fong
LICENSING EVALUATOR NAME: Catherine Lin
LICENSING EVALUATOR SIGNATURE: DATE: 05/16/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/16/2022
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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