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

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 019201087
Report Date: 07/10/2024
Date Signed: 07/10/2024 12:22:31 PM

Document Has Been Signed on 07/10/2024 12:22 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:EMPOWERING VISIONS IIFACILITY NUMBER:
019201087
ADMINISTRATOR/
DIRECTOR:
TAYLOR, CORSHEMAFACILITY TYPE:
735
ADDRESS:247 FOLSOM AVE.TELEPHONE:
(510) 397-1983
CITY:HAYWARDSTATE: CAZIP CODE:
94544
CAPACITY: 4CENSUS: 4DATE:
07/10/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:00 AM
MET WITH:Coeshema Taylor, AdministratorTIME VISIT/
INSPECTION COMPLETED:
12:45 PM
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 today’s date at 9:00 AM, Licensing Program Analyst (LPA) K. Nguyen arrived unannounced to conduct Required 1 Year Annual inspection. LPA met with DSP staff, Margarita Mandoza and explained the purpose of the visit. Administrator, Corshema Taylor, joined the visit at 11:00 AM. The facility’s fire clearance is approved for 4 Ambulatory.

LPA toured the facility including but not limited to bedrooms, bathrooms, kitchen, common area and backyard. The facility consists of 3 total bedrooms which all bedrooms are occupied by the clients. All outdoor and indoor passageways are kept free of obstruction. There are no bodies of water. A comfortable temperature for clients is maintained at 68-degree Fahrenheit. LPA observed lighting in all rooms are adequate for the comfort and safety of the clients. Hot water temperature in the shared clients’ bathroom was measured at 111-degree Fahrenheit. All toilets, hand washing, and bathing are safe, sanitary and in operating condition. There is a minimum of 7-day supply of non-perishables and 2-day perishables food supply.

Smoke detectors and carbon monoxide were in operating condition during visit. Fire extinguisher was last serviced on 12/6/2023. Emergency Disaster Drill was last posted on 7/2/2024. First aid kit was observed to be complete. Fire drill was last conducted on 6/18/2024.

At 11:20AM, clients’ records were reviewed. At 11:55 AM, 2 staff records were reviewed, and 2 of 2 have current first aid training and are associated to the facility.

No deficiencies were cited during this inspection and a copy of this report provided via email.
SUPERVISORS NAME: Bennett Fong
LICENSING EVALUATOR NAME: Kelly Nguyen
LICENSING EVALUATOR SIGNATURE: DATE: 07/10/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/10/2024
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