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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 019201069
Report Date: 01/30/2025
Date Signed: 01/30/2025 01:26:04 PM

Document Has Been Signed on 01/30/2025 01:26 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:GENTLE HEART CARE SERVICES INCFACILITY NUMBER:
019201069
ADMINISTRATOR/
DIRECTOR:		SPENCER, ALANNAFACILITY TYPE:
735
ADDRESS:1559 D STREETTELEPHONE:
(510) 397-4813
CITY:HAYWARDSTATE: CAZIP CODE:
94541
CAPACITY: 6CENSUS: 6DATE:
01/30/2025
TYPE OF VISIT:POCUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
12:40 PM
MET WITH:Sameer Aziz/Staff-Case ManagerTIME VISIT/
INSPECTION COMPLETED:
01:30 PM
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Licensing Program Analyst (LPA) Delmundo arrived unannounced to conduct proof of correction (POC) visit. LPA met with staff, Sameer Aziz, and informed the purpose of visit. LPA called and spoke over the phone with Alanna Spencer, administrator (ADM), and informed about the non-submission of POCS for the citations issued on 1/08/25 for deficiencies for a complaint and case management. LPA further informed the ADM that civil penalties (CPs) will be issued on this day, and that the CPs will continue for $100.00/day until corrected.

On 1/08/25, LPA Delmundo issued the following citations with 1/22/25 due date to submit the POCs:
1. Complaint
Deficiency section # 80022(k)
Civil penalty = $100.00 x 8 days (1/23/25 to 1/30/25) = $800.00
2. Case management
Deficiency section # 80061(b)(E)
Civil penalty = $100.00 x 8 days (1/23/25 to 1/30/25) = $800.00

The civil penalties were discussed with the ADM over the phone in the presence of Sameer Aziz. LPA asked, and ADM state she can not come to the facility, and authorized Sameer Aziz to sign and receive this report.

Exit interview conducted. Appeal Rights, LIC421FCs Civil Penalty Assessments, LIC9098 Proof of Correction forms, and copy of this report provided.
SUPERVISORS NAME: Bennett Fong
LICENSING EVALUATOR NAME: Alicia Delmundo
LICENSING EVALUATOR SIGNATURE: DATE: 01/30/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/30/2025
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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