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Department of
SOCIAL SERVICES
Community Care Licensing
FACILITY EVALUATION REPORT
Facility Number:
073401984
Report Date:
09/11/2024
Date Signed:
09/13/2024 09:46:59 AM
COMPREHENSIVE INSPECTION
Document Has Been Signed on
09/13/2024 09:46 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 CC RO
,
1515 CLAY STREET, SUITE 1102
OAKLAND
,
CA
94612
FACILITY NAME:
HUSKY HOUSE, INC.
FACILITY NUMBER:
073401984
ADMINISTRATOR/
DIRECTOR:
ANN REARDEN
FACILITY TYPE:
840
ADDRESS:
3855 HAPPY VALLEY ROAD
TELEPHONE:
(925) 283-7100
CITY:
LAFAYETTE
STATE:
CA
ZIP CODE:
94549
CAPACITY:
120
TOTAL ENROLLED CHILDREN:
151
CENSUS:
28
DATE:
09/11/2024
TYPE OF VISIT:
Annual/Random
UNANNOUNCED
TIME VISIT/
INSPECTION BEGAN:
12:45 PM
MET WITH:
Anne Reardon/Monica Moran
TIME VISIT/
INSPECTION COMPLETED:
03:45 PM
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On 09/11/2024 LPA A. Curry conducted an annual/random inspection. All reports from that day disappeared and are not showing in the Field Automation System. Copies of the signed report were retrieved and placed in facility's file.
No deficiencies were cited during the inspection on 09/11/2024.
SUPERVISORS NAME
:
Monica Mathur
LICENSING EVALUATOR NAME
:
Ashley Curry
LICENSING EVALUATOR SIGNATURE
:
DATE:
09/13/2024
I acknowledge receipt of this form and understand my
licensing
appeal rights as
explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE:
09/13/2024
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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