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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 079200198
Report Date: 01/31/2023
Date Signed: 01/31/2023 01:53:18 PM

Document Has Been Signed on 01/31/2023 01:53 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:MISSION-HOPE DAY PROGRAM BRENTWOODFACILITY NUMBER:
079200198
ADMINISTRATOR:JIAN GAMEZFACILITY TYPE:
775
ADDRESS:350 PEACHTREE COURTTELEPHONE:
(925) 516-2222
CITY:BRENTWOODSTATE: CAZIP CODE:
94513
CAPACITY: 30CENSUS: 32DATE:
01/31/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
12:38 PM
MET WITH:Ve Ly, Program Director TIME COMPLETED:
02:10 PM
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On 01/31/2023 Licensing Program Analyst (LPA) L. Ibo arrived unannounced to conduct an annual infection control inspection. LPA met with Program director Ve Ly and informed the purpose the visit. Facility have census of 32. LPA observed clients conducting different kinds of activities.

LPA toured the program with Program Director Ve Ly including but not limited to the bathroom, common area, and washing station. LPA observed the facility to be free of odor, clean and in good repair. Outdoor space is provided and is free of hazards. Clients bring their own lunch, however for instances that clients do not bring their lunch then the program can provide snacks for them. Toilets and hand washing stations are maintained in a safe, sanitary, operating condition. There are no bodies of water or fire safety hazards observed during visit. Indoor and outdoor passageways were kept free of obstruction. Cleaning supplies were locked in a storage room.



There was an enough supply of toiletry supplies & PPE supplies. There are locked cabinets available to store toxins and medications. The facility is equipped with fire extinguishers, smoke detectors, carbon monoxide detectors and a complete first aid kit.

No deficiency cited during the visit.

Exit interview conducted with Program Director. Copy of this report provided

SUPERVISORS NAME: Harpreet Humpal
LICENSING EVALUATOR NAME: Leslie Ibo
LICENSING EVALUATOR SIGNATURE: DATE: 01/31/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/31/2023
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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