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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 019200891
Report Date: 12/20/2021
Date Signed: 12/20/2021 03:08:41 PM

Document Has Been Signed on 12/20/2021 03:08 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:HEIWA GROWTH HOUSE 2FACILITY NUMBER:
019200891
ADMINISTRATOR:ONO, YUKAFACILITY TYPE:
735
ADDRESS:24527 MARIE DRTELEPHONE:
(510) 677-6889
CITY:HAYWARDSTATE: CAZIP CODE:
94542
CAPACITY: 6CENSUS: 0DATE:
12/20/2021
TYPE OF VISIT:Case Management - Annual ContinuationANNOUNCEDTIME BEGAN:
01:55 PM
MET WITH:Caregiver, Lamin DrammehTIME COMPLETED:
03:15 PM
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On 12/20/2021 at 1:55 pm, Licensing Program Analyst (LPAs) L. Holmes and C. Fowler conducted a announced Infection Control Inspection. LPAs met Caregiver, Lamin Drammeh and explained the purpose of the visit. The Administrator, Yuka Ono was called and she stated that Lamin Drammeh could conduct the visit.

There aren't any clients at this time. Upon entry, LPAs temperature was not checked. LPAs did not observed screening station that contained hand sanitizer, masks. LPAs toured facility including but not limited to common areas, bathrooms, bedrooms, kitchen, garage and backyard. LPAs observed handwashing, cough etiquette, and mask signs posted in the common areas. All hand washing stations were equipped with soap, and paper towels, LPAs observed facility has a copy of Mitigation Plan on file.

LPAs advised caregiver of the following:
Purchase additional PPE's, post Emergency Disaster Plan, place covered garbage cans in two bathrooms, add 20 seconds to handwashing signs at kitchen and bathrooms.



Exit interview conducted with Caregiver. A copy of this report provided.
SUPERVISORS NAME: Yvonne Flores-Larios
LICENSING EVALUATOR NAME: Lisha Holmes
LICENSING EVALUATOR SIGNATURE: DATE: 12/20/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/20/2021
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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