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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 019201074
Report Date: 03/27/2023
Date Signed: 03/27/2023 02:09:04 PM

Document Has Been Signed on 03/27/2023 02:09 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: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: 27DATE:
03/27/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
11:35 AM
MET WITH:Allen Henry, AdministratorTIME COMPLETED:
02:15 PM
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On 3/27/23 11:35 a.m., Licensing Program Analyst (LPA) Greg Clark arrived unannounced to conduct 1-Year Annual Required inspection. LPA met with Administrator Allen Henry and explained the purpose of the visit. Day program operates from 8:30 AM to 3:30 PM. There were 5 staff observed working with the 27 clients here today.

LPA toured facility including but not limited to, multiple activity rooms, kitchen, bathrooms, office space, and the outside recreational area. Clients bring their own lunches and snacks are provided by the program. Emergency supplies, including water were observed. The hot water temperature in the client bathroom measured 116.5 degrees Fahrenheit. Cleaning supplies are locked and inaccessible to clients. Medications are not handled/dispensed by this program. There are no bodies of water or fire safety hazards observed. Restrooms are maintained in safe and in sanitary operating condition, and additional equipment for the physically handicapped was observed. The facility is clean and free of odors. LPA reviewed 5 client and 5 staff files for sampling. All were complete and up-to-date. LPA also interviewed 5 program participates and 5 staff. Emergency disaster drills are conducted on a monthly basis at different times. Fire extinguishers throughout facility were last inspected 1/31/23. First aid kit was checked and observed to be complete.

No deficiencies cited during visit. Exit interview conducted and a copy of this report provided.
SUPERVISORS NAME: Yvonne Flores-Larios
LICENSING EVALUATOR NAME: Gregory Clark
LICENSING EVALUATOR SIGNATURE: DATE: 03/27/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/27/2023
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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