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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 019201038
Report Date: 05/12/2023
Date Signed: 05/12/2023 02:50:18 PM

Document Has Been Signed on 05/12/2023 02:50 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:REACHING MILE STONESFACILITY NUMBER:
019201038
ADMINISTRATOR:PORTER, BETTYFACILITY TYPE:
735
ADDRESS:2869 FORD ST # ATELEPHONE:
(510) 463-7483
CITY:OAKLANDSTATE: CAZIP CODE:
94601
CAPACITY: 3CENSUS: 3DATE:
05/12/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
01:20 PM
MET WITH:Jackie Sandoval, Care GiverTIME COMPLETED:
02:55 PM
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On 5/12/23 at 1:20 PM, Licensing Program Analyst (LPA) Greg Clark arrived unannounced to conduct 1-Year Annual Required inspection. LPA spoke with Administrator,Betty Porter and explained the purpose of the visit. Ms. Porter informed LPA that Care Giver Jackie Sandoval can sign the report. The facility’s fire clearance was approved for 3 ambulatory residents.

LPA toured the facility including but not limited to bedrooms, bathrooms, kitchen, common area and backyard. The facility consists of 3 total bedrooms of which 3 bedrooms are occupied by the clients. All outdoor and indoor passageways are kept free of obstruction. There are no bodies of water. A comfortable temperature for clients is maintained at 68 degree Fahrenheit. LPA observed lighting in all rooms are adequate for the comfort and safety of the clients. Hot water temperature in the kitchen sink was measured at 117.5 degree Fahrenheit. All toilets, hand washing and bathing are safe, sanitary and in operating condition. The supply of extra hygiene were available for clients. There is a minimum of one-week supply of non-perishables and 2-day perishables food supply.

Smoke detectors and carbon monoxide were in operating condition during visit. Fire extinguisher was last serviced on 5/23/22. First aid kit was observed to be complete. Fire drill was last conducted on 3/17/23.

At 1:40 p.m, 3 of 3 clients records were reviewed. At 2:00 p.m., 4 of 4 staff records were reviewed and 4 of 4 have current first aid training and are associated to the facility. A sample of 2 client’s medications were reviewed.

Updated copies of the following documents were requested for facility file and are to be submitted to CCL by 5/19/23:

LIC 610E Emergency Disaster Plan

No deficiencies were cited during this inspection. Exit interview conducted and a copy of this report provided.
SUPERVISORS NAME: Yvonne Flores-Larios
LICENSING EVALUATOR NAME: Gregory Clark
LICENSING EVALUATOR SIGNATURE: DATE: 05/12/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/12/2023
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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