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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 019200761
Report Date: 08/16/2022
Date Signed: 08/16/2022 04:43:48 PM


Document Has Been Signed on 08/16/2022 04:43 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:FREMONT HILLSFACILITY NUMBER:
019200761
ADMINISTRATOR:BERNADETTE MILOFACILITY TYPE:
740
ADDRESS:35490 MISSION BLVDTELEPHONE:
(510) 796-4200
CITY:FREMONTSTATE: CAZIP CODE:
94536
CAPACITY:140CENSUS: 72DATE:
08/16/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
04:15 PM
MET WITH:Stephanie Thune-Barnes, Managing DirectorTIME COMPLETED:
04:55 PM
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On 8/16/2022 at 4:15PM Licensing Program Analysts (LPA) L. Hall and L. Fici arrived unannounced to conduct a Case Management visit. LPAs met with Stefanie Thune-Barnes, Managing Director.

LPAs went to the facility to deliver an Immediate Exclusion letter. LPAs verified that Staff 2 (S2) was not present at the facility. LPAs advised Staff 1 (S1) that S2 shall be removed from guardian.

No deficiencies cited during visit.

Exit interview conducted. A copy of exclusion letter and report provided.

SUPERVISOR'S NAME: Harpreet HumpalTELEPHONE: (510) 285-3928
LICENSING EVALUATOR NAME: Laura HallTELEPHONE: (510) 622-2024
LICENSING EVALUATOR SIGNATURE:
DATE: 08/16/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/16/2022
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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