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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 019201329
Report Date: 08/16/2024
Date Signed: 08/16/2024 03:03:20 PM


Document Has Been Signed on 08/16/2024 03:03 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:IVY PARK OF OAKLAND HILLSFACILITY NUMBER:
019201329
ADMINISTRATOR:HARRELL, YOLANDAFACILITY TYPE:
740
ADDRESS:11889 SKYLINE BOULEVARDTELEPHONE:
(510) 531-7190
CITY:OAKLANDSTATE: CAZIP CODE:
94619
CAPACITY:100CENSUS: 60DATE:
08/16/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
02:00 PM
MET WITH:Yolanda HarrellTIME COMPLETED:
03:15 PM
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On this day at around 2:30 pm, LPAs Luisa Fontanilla and Ardalan Gharachorloo conducted Component lll with Executive Director (ED) Yolanda Harrell.

Caseload LPA Gharachorloo presented Component lll power point presentation with ED.

A copy of this report was provided to ED.
SUPERVISOR'S NAME: Yvonne Flores-LariosTELEPHONE: (510) 286-0517
LICENSING EVALUATOR NAME: Luisa FontanillaTELEPHONE: (510) 286-7147
LICENSING EVALUATOR SIGNATURE:
DATE: 08/16/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/16/2024
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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