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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 019201074
Report Date: 03/17/2022
Date Signed: 03/17/2022 11:35:37 AM

Document Has Been Signed on 03/17/2022 11:35 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
CCLD Regional Office, 1515 CLAY STREET, STE. 310
OAKLAND, CA 94612
FACILITY NAME:HENRY & HENRY ADULT DAY PROGRAM IIFACILITY NUMBER:
019201074
ADMINISTRATOR:HENRY, ALLENFACILITY TYPE:
775
ADDRESS:2614 SEMINARY AVENUETELEPHONE:
(510) 530-3800
CITY:OAKLANDSTATE: CAZIP CODE:
94605
CAPACITY: 100CENSUS: 0DATE:
03/17/2022
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
11:03 AM
MET WITH:Allen Henry, DirectorTIME COMPLETED:
11:45 AM
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On 03/17/22 at 11:03 a.m. Licensing Program Analyst (LPA) Greg Clark arrived announced to conduct pre-licensing inspection. LPA met with Administrator, Allen Henry and explained the purpose of the visit. The facility currently has no clients.

LPA toured facility including but not limited to: bathrooms, common areas, breakout rooms and backyard. Activity rooms were equipped with the proper basic furniture. Much of the furniture and activity supplies will be moved from the existing location on International Blvd. Oakland. Bathrooms were equipped with grab bars and non-skid mats.There is sufficient lighting throughout facility. First-aid kit was observed to be complete. Smoke detectors and carbon monoxide were operational. Fire extinguisher was last serviced on 07/19/21. Proper COVID mitigation (Infection Control) signs was observed throughout the facility.


No issues noted during inspection. LPA observed that facility is ready to be licensed. This report will be submitted to the Central Applications Unit (CAU) and a final review of the application will be conducted. This facility is not yet licensed, and is subject to final approval by CAU. Additional requirements may still be required.

Exit interview conducted and a copy of this report provided.
SUPERVISORS NAME: Yvonne Flores-Larios
LICENSING EVALUATOR NAME: Gregory Clark
LICENSING EVALUATOR SIGNATURE: DATE: 03/17/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/17/2022
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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