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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 019201428
Report Date: 02/13/2025
Date Signed: 02/13/2025 02:23:39 PM

Document Has Been Signed on 02/13/2025 02:23 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
OAKLAND ASC, 1515 CLAY STREET, STE. 310
OAKLAND, CA 94612
FACILITY NAME:FCSN ADAPTIVE SKILLS TRAININGFACILITY NUMBER:
019201428
ADMINISTRATOR/
DIRECTOR:		CHIAO, LINMEIFACILITY TYPE:
775
ADDRESS:2190 PERALTA BLVD.TELEPHONE:
(510) 739-6900
CITY:FREMONTSTATE: CAZIP CODE:
94536
CAPACITY: 20CENSUS: 0DATE:
02/13/2025
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:00 AM
MET WITH:Linmei, Chiao, Program Director TIME VISIT/
INSPECTION COMPLETED:
01:35 PM
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On 02/13/2025 at 10:00 AM , Licensing Program Analysts (LPAs) P. Manalo and L. Fontanilla came to the facility unannounced to conduct pre licensing inspection. LPAs waited for the Licensee/ Applicant to arrive, but was not available. LPAs left to do another visit, and came back at 12:30 PM. LPAs met with Licensee/Applicant, Linmei Chiao and Assistant Program Director, Amanda Hsu,
and explained the purpose of the visit. The facility has an approved fire clearance for a capacity of twenty (20) ambulatory.

LPAs toured facility including but not limited to the lobby, kitchen, storage room, community room, and two bathrooms. LPAs observed lighting in all rooms. Smoke detectors are interconnected. Carbon monoxide detector was observed in operating condition. First aid kit was complete. Emergency disaster plan was complete. Fire extinguisher was observed to be full and last served on 8/13/2024.

The following will need to be completed before recommending licensure to Centralized Application Bureau (CAB):

1. Hot water was measured at 128.6 degrees Fahrenheit in the hallway bathroom sink.

This facility is not yet licensed, and is subject to final approval by CAB. Additional requirements may still be required.



Exit interview conducted and a copy of this report was provided to Licensee/applicant.
SUPERVISORS NAME: Yvonne Flores-Larios
LICENSING EVALUATOR NAME: Patricia Manalo
LICENSING EVALUATOR SIGNATURE: DATE: 02/13/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/13/2025
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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