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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 019201359
Report Date: 07/22/2024
Date Signed: 07/22/2024 11:40:06 AM

Document Has Been Signed on 07/22/2024 11:40 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
CCLD Regional Office, 1515 CLAY STREET, STE. 310
OAKLAND, CA 94612
FACILITY NAME:FCSN L.E.A.D. ADULT TRAINING PROGRAMFACILITY NUMBER:
019201359
ADMINISTRATOR/
DIRECTOR:		YEH, SYLVIAFACILITY TYPE:
775
ADDRESS:42080 OSGOOD RD SUITE 101TELEPHONE:
(510) 739-6900
CITY:FREMONTSTATE: CAZIP CODE:
94539
CAPACITY: 75CENSUS: 0DATE:
07/22/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:45 AM
MET WITH:Vivian Largusa, Program Director
Sylvia Yeh, Executive Director		TIME VISIT/
INSPECTION COMPLETED:
11:50 AM
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On 7/22/2024 at 10:45AM, Licensing Program Analyst (LPA) G. Luk conducted a face to face Component III presentation. LPA met with Program Director, Vivian Largusa and Executive Director, Sylvia Yeh.

LPA presented Component III power point and discussed the regulations embodied in the presentation. LPA observed Program Director and Executive Director gained knowledge about running and maintaining the facility in accordance with Title 22 regulations.

LPA concluded Component III.

Exit interview conducted and a copy of this report provided.

SUPERVISORS NAME: Harpreet Humpal
LICENSING EVALUATOR NAME: Grace Luk
LICENSING EVALUATOR SIGNATURE: DATE: 07/22/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/22/2024
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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