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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 079200313
Report Date: 03/21/2024
Date Signed: 03/21/2024 12:38:23 PM

Document Has Been Signed on 03/21/2024 12:38 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:COLE VOCATIONAL SERVICES PINOLEFACILITY NUMBER:
079200313
ADMINISTRATOR:SHANISHIA EVANSFACILITY TYPE:
775
ADDRESS:2401-A SAN PABLO AVETELEPHONE:
(510) 724-7190
CITY:PINOLESTATE: CAZIP CODE:
94564
CAPACITY: 45CENSUS: 22DATE:
03/21/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:45 AM
MET WITH:SHANISHIA EVANS, PROGRAM DIRECTORTIME COMPLETED:
12:50 PM
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On 03/21/2024 at 09:45 AM, Licensing Program Analyst (LPA) Carol Fowler arrived unannounced to conduct 1-Year Annual Required inspection. LPA met with Program Director, Shanishia Evans and explained the purpose of the visit. Day program operates from 9:00AM to 3:00PM. There were staff observed working with the 22 clients here today.

LPA toured facility with Program Supervisor Wendy Arellano including but not limited to, multiple activity rooms, kitchen, bathrooms and office space. Clients bring their own lunches and snacks. Emergency supplies, including water were observed. The hot water temperature in the client bathroom measured 115.5 degrees Fahrenheit. Cleaning supplies are locked and inaccessible to clients. Medications are not handled/dispensed by this program at this time. There are no bodies of water or fire safety hazards observed. Restrooms are maintained in safe and in sanitary operating condition, and additional equipment for the physically handicapped was observed. Incontinent clients are kept clean and dry, and the facility is free of odors. There is a comfortable room temperature of 70 degrees Fahrenheit for clients in care. The motor vehicle used to transport clients is maintained in a safe operating condition. LPA Reviewed eight (8) client and three (3) staff files for sampling which were all complete. Emergency disaster drills are conducted bi-annually and fire drills on a monthly basis last drill was conducted on 2/27/2024. Fire extinguishers throughout facility were last serviced on 11/10/2023. Emergency Disaster Plan was last updated on 3/8/2023. First aid kit was complete.
SUPERVISORS NAME: Bennett Fong
LICENSING EVALUATOR NAME: Carol Fowler
LICENSING EVALUATOR SIGNATURE: DATE: 03/21/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/21/2024
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1515 CLAY STREET, STE. 310
OAKLAND, CA 94612
FACILITY NAME: COLE VOCATIONAL SERVICES PINOLE
FACILITY NUMBER: 079200313
VISIT DATE: 03/21/2024
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Continue from LIC809

The following forms to be updated and submitted to CCL by 03/29/2023:

LIC 308 Designation of Administrative Responsibility
LIC 309 Administrative Organization
LIC 610D Emergency Disaster Plan

No deficiencies were cited during this inspection.
SUPERVISORS NAME: Bennett Fong
LICENSING EVALUATOR NAME: Carol Fowler
LICENSING EVALUATOR SIGNATURE:

DATE: 03/21/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/21/2024
LIC809 (FAS) - (06/04)
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