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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 019201369
Report Date: 07/03/2024
Date Signed: 07/03/2024 01:52:41 PM

Document Has Been Signed on 07/03/2024 01:52 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:HOSPITABLE HEARTSFACILITY NUMBER:
019201369
ADMINISTRATOR/
DIRECTOR:		HALL, BRITTNEY EDWARDSFACILITY TYPE:
735
ADDRESS:557 33RD STREET #2TELEPHONE:
(510) 313-3595
CITY:OAKLANDSTATE: CAZIP CODE:
94609
CAPACITY: 3CENSUS: 0DATE:
07/03/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
12:55 PM
MET WITH:Britney Edwards Hall/Applicant-AdministratorTIME VISIT/
INSPECTION COMPLETED:
01:55 PM
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Licensing Program Analyst (LPA) Delmundo conducted an announced Component III Training via Teams Meeting. Component III was attended by Britney Edwards Hall, applicant-administrator.

LPA presented the training via Power Point presentation, and had a discussion with the applicant.

Exit interview conducted, and copy of this report provided at the conclusion of the training.
SUPERVISORS NAME: Bennett Fong
LICENSING EVALUATOR NAME: Alicia Delmundo
LICENSING EVALUATOR SIGNATURE: DATE: 07/03/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/03/2024
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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