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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 019201048
Report Date: 03/12/2025
Date Signed: 03/12/2025 11:53:58 AM

Document Has Been Signed on 03/12/2025 11:53 AM - 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:REM CALIFORNIA LLC - ASHLANDFACILITY NUMBER:
019201048
ADMINISTRATOR/
DIRECTOR:		DELLA BOUGHTONFACILITY TYPE:
775
ADDRESS:29800 MISSION BLVDTELEPHONE:
(510) 881-1018
CITY:HAYWARDSTATE: CAZIP CODE:
94544
CAPACITY: 60CENSUS: 22DATE:
03/12/2025
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:15 AM
MET WITH:Della Boughton, Program DirectorTIME VISIT/
INSPECTION COMPLETED:
12:05 PM
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On 03/12/2025 at 10:15 AM, Licensing Program Analysts (LPAs) P. Manalo and K. Nguyen arrived unannounced to conduct 1-Year Annual Required inspection. LPAs met with Program Director, Della Boughton and explained the purpose of the visit. Day program operates from Monday to Friday 8:30 AM to 3:00 PM.

During the visit, LPAs inspected the Adult Day Program (ADP) including but not limited to bathroom, two activity room, reading room, resting room, etc. Hot water temperature measured at 109.5 degrees Fahrenheit in the bathroom. There were fire extinguishers observed and last serviced on 03/21/2024. Room temperature was observed at 70 degrees Fahrenheit. Emergency Disaster Drill was conducted on 02/04/25.

LPAS reviewed 5 staff and 5 client files. All staff are fingerprint cleared and associated to the ADP.

No deficiencies cited during visit. Exit interview conducted and a copy of this report provided.
SUPERVISORS NAME: Yvonne Flores-Larios
LICENSING EVALUATOR NAME: Patricia Manalo
LICENSING EVALUATOR SIGNATURE: DATE: 03/12/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/12/2025
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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