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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 019201302
Report Date: 11/13/2024
Date Signed: 12/05/2024 10:24:01 AM

Document Has Been Signed on 12/05/2024 10:24 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
OAKLAND ASC, 1515 CLAY STREET, STE. 310
OAKLAND, CA 94612
FACILITY NAME:WARNER HOME #3FACILITY NUMBER:
019201302
ADMINISTRATOR/
DIRECTOR:
SLOAN, PAMELAFACILITY TYPE:
735
ADDRESS:36951 MULBERRY STREETTELEPHONE:
(831) 917-2870
CITY:NEWARKSTATE: CAZIP CODE:
94560
CAPACITY: 6CENSUS: 0DATE:
11/13/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:10 AM
MET WITH:Pamela SloanTIME VISIT/
INSPECTION COMPLETED:
10:35 AM
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On this day at around 9:10 am, Licensing Program Analysts (LPAs) L. Fontanilla and P. Manalo arrived announced to conduct an annual required inspection and met with Administrator Pamela Sloan and Armand Galleon. The facility is vendorized by the Regional Center of the East Bay (RCEB). The facility does not have any client yet.

During the visit, LPAs inspected the facility inside and out including but not limited to bedrooms, bathrooms, kitchen, common areas, etc. Hot water measured at 136.4 Fahrenheit. Fire extinguishers were observed to be full and last inspected on 5/31/2024. The facility is observed to be clean and odor free.

At 9:40 AM, LPAs reviewed the staff files. Staff files are up to date and complete.

Updated copies of the following documents were requested for facility file and are to be submitted to CCL by 12/12/2024:

LIC 308 Designation of Administrative Responsibility
LIC 309 Administrative Organization
LIC 500 Personnel Report
LIC 610 Emergency Disaster Plan
Liability Insurance
Current Administrator’s Certificate
Updated Infection Control Plan

No deficiencies cited during visit. Exit interview conducted and a copy of this report provided.
SUPERVISORS NAME: Yvonne Flores-Larios
LICENSING EVALUATOR NAME: Patricia Manalo
LICENSING EVALUATOR SIGNATURE: DATE: 11/13/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/13/2024
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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