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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 019201063
Report Date: 08/04/2022
Date Signed: 08/04/2022 02:05:12 PM


Document Has Been Signed on 08/04/2022 02:05 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:AEGIS GARDENSFACILITY NUMBER:
019201063
ADMINISTRATOR:POON, EMILYFACILITY TYPE:
740
ADDRESS:36281 FREMONT BLVDTELEPHONE:
(949) 488-2669
CITY:FREMONTSTATE: CAZIP CODE:
94536
CAPACITY:85CENSUS: 73DATE:
08/04/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
01:10 PM
MET WITH:Cathy Zhou- Health and Service DirectorTIME COMPLETED:
02:15 PM
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On today’s date around 1:10 PM. Licensing Program Analyst (LPA) L. Fici and Licensing Program Manager (LPM) Y. Flores-Larios arrived unannounced to conduct a case management visit. LPA and LPM met Health and Services Director, Cathy Zhou and explained the purpose of the visit.

During inspection conducted on 7/20/2022, census was reported as 97; however, facility is licensed for 85. LPA and LPM requested residents roster which reflected census of 73. LPA and LPM conducted an interview with Emily Poon- General Manager (GM). GM stated that the census is 97% as they only have two vacant apartments at the moment, Facility capacity is under 85. Current census is 73. LPA and LPM confirmed facility is not over capacity.

No deficiencies cited on todays visit.

Exit interview conducted with General Manager. Copy of report was handed to provider.
SUPERVISOR'S NAME: Yvonne Flores-LariosTELEPHONE: (510) 286-0517
LICENSING EVALUATOR NAME: Liridon FiciTELEPHONE: (510) 359-0768
LICENSING EVALUATOR SIGNATURE:
DATE: 08/04/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/04/2022
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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