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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 019201157
Report Date: 07/17/2024
Date Signed: 07/17/2024 03:01:04 PM

Document Has Been Signed on 07/17/2024 03:01 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:MITC EAST BAYFACILITY NUMBER:
019201157
ADMINISTRATOR/
DIRECTOR:		MENDOZA, GABRIELFACILITY TYPE:
775
ADDRESS:2192 E 14TH STTELEPHONE:
(510) 904-5966
CITY:SAN LEANDROSTATE: CAZIP CODE:
94577
CAPACITY: 70CENSUS: 3DATE:
07/17/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:30 PM
MET WITH:Gabriel Mendoza, AdministratorTIME VISIT/
INSPECTION COMPLETED:
03:15 PM
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On 7/17/24 at 1:30 p.m., Licensing Program Analyst (LPA) Greg Clark arrived unannounced to conduct 1-Year Annual Required inspection. LPA met with Administrator Gabriel Mendoza and explained the purpose of the visit. Day program operates from 8:30 a.m. to 2:00 p.m. Monday to Friday.

LPA toured facility including but not limited to: activity rooms, bathrooms, office space, and the outside recreational area. Clients bring their own lunches. Emergency supplies, including water were observed. The hot water temperature in the shared bathroom measured 14.2 degrees Fahrenheit. Cleaning supplies are locked and inaccessible to clients. 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. Incontinent clients are kept clean and dry, and the facility is free of odors. The program has 5 vans used for client outings and transportation. LPA observed 2 that were on the premises were observed to be clean.

First aid kit was checked and observed to be complete. Emergency Disaster Plan was last posted on 3/30/24.

LPA reviewed 5 participant records and 5 staff records, and all were complete.

No deficiencies were cited during this inspection. Exit interview conducted and a copy of this report provided.
SUPERVISORS NAME: Yvonne Flores-Larios
LICENSING EVALUATOR NAME: Gregory Clark
LICENSING EVALUATOR SIGNATURE: DATE: 07/17/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/17/2024
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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