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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 079200198
Report Date: 01/30/2025
Date Signed: 01/30/2025 03:41:25 PM

Document Has Been Signed on 01/30/2025 03:41 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:MISSION-HOPE DAY PROGRAM BRENTWOODFACILITY NUMBER:
079200198
ADMINISTRATOR/
DIRECTOR:		JIAN GAMEZFACILITY TYPE:
775
ADDRESS:350 PEACHTREE COURTTELEPHONE:
(925) 516-2222
CITY:BRENTWOODSTATE: CAZIP CODE:
94513
CAPACITY: 30CENSUS: 30DATE:
01/30/2025
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
02:10 PM
MET WITH:Vy Le, Program Director TIME VISIT/
INSPECTION COMPLETED:
04:00 PM
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On 01/30/2025 at 2:10PM Licensing Program Analyst (LPA) T. Syess-Gibson arrived unannounced to conduct 1-Year Annual Required inspection. LPA met with Vy Le, Program Director and explained the purpose of the visit. Fire clearance approved for two (2) non ambulatory and twenty-eight (28) ambulatory clients.

LPA toured facility including but not limited to activity rooms, kitchen, bathrooms, office space, and the outside recreational area. Clients bring their own lunches and snacks are provided by the program. Emergency supplies, including water were observed. The hot water temperature in the shared bathroom measured 105.0 degrees Fahrenheit. There is a comfortable room temperature of 68 degrees Fahrenheit for clients in care. Medications and toxins are locked in a cabinet and inaccessible to clients in care. There are no bodies of water or fire safety hazards observed. Restrooms are maintained in safe and in sanitary operating condition. Incontinent clients are kept clean and dry, and the facility is free of odors. The program has seven (7) vans used for client outings and transportation.

LPA reviewed 5 client and 5 staff files; all were complete. Emergency disaster drills are conducted on a monthly basis. Fire extinguishers throughout facility were last inspected 09/19/2024. First aid kit was checked and observed to be complete.

Continue on LIC809C
SUPERVISORS NAME: Harpreet Humpal
LICENSING EVALUATOR NAME: Tonica Syess-Gibson
LICENSING EVALUATOR SIGNATURE: DATE: 01/30/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/30/2025
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
OAKLAND ASC, 1515 CLAY STREET, STE. 310
OAKLAND, CA 94612
FACILITY NAME: MISSION-HOPE DAY PROGRAM BRENTWOOD
FACILITY NUMBER: 079200198
VISIT DATE: 01/30/2025
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Continued from LIC809.


LPA reviewed five (5) staff record, and all staff have first aid certification and associated to facility. LPA reviewed five (5) clients' records they were current, and complete.

The following forms to be updated and submitted to CCLD by 02/06/2025:
  • LIC 308 Designation of Administrative Responsibility
  • LIC 610D Emergency Disaster Plan (9 pages)


No deficiencies were cited during this inspection.

Exit interview conducted and a copy of this report provided.

SUPERVISORS NAME: Harpreet Humpal
LICENSING EVALUATOR NAME: Tonica Syess-Gibson
LICENSING EVALUATOR SIGNATURE:

DATE: 01/30/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/30/2025
LIC809 (FAS) - (06/04)
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