<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 019201075
Report Date: 11/13/2023
Date Signed: 11/13/2023 03:04:18 PM

Document Has Been Signed on 11/13/2023 03:04 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:A RAY OF SUNSHINEFACILITY NUMBER:
019201075
ADMINISTRATOR:LEE-GONZALES, MESALINA G.FACILITY TYPE:
735
ADDRESS:8111 ALDEA STREETTELEPHONE:
(510) 676-6427
CITY:DUBLINSTATE: CAZIP CODE:
94568
CAPACITY: 6CENSUS: 4DATE:
11/13/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
11:25 AM
MET WITH:LEE-GONZALES, MESALINA G., AdministratorTIME COMPLETED:
11:50 AM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
On 11/13/2023 Licensing Program Analyst (LPA) K. Nguyen conducted an unannounced case management visit regarding upon the incident LPA received on 11/4/2023. C1 was attract by C1 roommate. LPA spoke with Mesalina, Administrator (AD) and explained the purpose of the visit.

LPA interviewed AD regarding client (C1) care prior to leading up to the incident. LPA discussed with AD on the following subject. AD agree to continue to monitor (C1) roommate. AD discussed with C1 mom that AD will be switching C1 to a different room. AD took action and moved C2 to different room in order for C1 safety, and all others clients'. AD discussed with in house specialist regarding the incident. AD discussed with C1 roommate case manger as well. AD is following up with everyone that is involved, and continued to document any changing in behavior or any new concerned client’s mom or anyone may have.

No deficiencies cited. Exit Interview conducted and a copy of this report provided via email.
SUPERVISORS NAME: Bennett Fong
LICENSING EVALUATOR NAME: Kelly Nguyen
LICENSING EVALUATOR SIGNATURE: DATE: 11/13/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/13/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 1