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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 079200313
Report Date: 02/12/2025
Date Signed: 02/12/2025 03:29:46 PM

Document Has Been Signed on 02/12/2025 03:29 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/
DIRECTOR:		SHANISHIA EVANSFACILITY TYPE:
775
ADDRESS:2401-A SAN PABLO AVETELEPHONE:
(510) 724-7190
CITY:PINOLESTATE: CAZIP CODE:
94564
CAPACITY: 45CENSUS: 34DATE:
02/12/2025
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
12:40 PM
MET WITH:Maia Giovannoli, QATIME VISIT/
INSPECTION COMPLETED:
03:45 PM
NARRATIVE
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On 02/12/2025 at 12:40PM, Licensing Program Analyst (LPA) Carol Fowler arrived unannounced to conduct 1-Year Annual Required inspection. LPA met with Maia Giovannoli, QA and explained the purpose of the visit. Day program operates from 9:00AM to 3:00PM. There were staff observed working with the 20 clients here today.

LPA toured facility with Maia Giovannoli, QA 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 xxx.x 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 74 degrees Fahrenheit for clients in care. The motor vehicle used to transport clients is maintained in a safe operating condition. LPA Reviewed five (5) 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 07/17/2024. Fire extinguishers throughout facility were last serviced on 12/05/2024. Emergency Disaster Plan was last updated on 03/21/2024. First aid kit was complete.

Deficiency observed during visit:
  • At 1:29pm LPA observed an unlocked cabinet located in the kitchen area which contained chemicals.


Continue from LIC809
SUPERVISORS NAME: Bennett Fong
LICENSING EVALUATOR NAME: Carol Fowler
LICENSING EVALUATOR SIGNATURE: DATE: 02/12/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/12/2025
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
CCLD Regional Office, 1515 CLAY STREET, STE. 310
OAKLAND, CA 94612
FACILITY NAME: COLE VOCATIONAL SERVICES PINOLE
FACILITY NUMBER: 079200313
VISIT DATE: 02/12/2025
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CONTINUE FROM LIC 809

The following forms were reviewed by the Department.

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

The following deficiencies were observed (see LIC 809D) and cited from the California Code of Regulations, Title 22 ,and California Health and Safety Code. Failure to correct deficiencies may result in civil penalties.

Exit interview conducted. A copy of this report and appeal rights provided.
SUPERVISORS NAME: Bennett Fong
LICENSING EVALUATOR NAME: Carol Fowler
LICENSING EVALUATOR SIGNATURE:

DATE: 02/12/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/12/2025
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 02/12/2025 03:29 PM - It Cannot Be Edited


Created By: Carol Fowler On 02/12/2025 at 03:10 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 1515 CLAY STREET, STE. 310
OAKLAND, CA 94612

FACILITY NAME: COLE VOCATIONAL SERVICES PINOLE
FACILITY NUMBER: 079200313

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/12/2025

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
CCR
82087(a)(3)
Buildings and Grounds
(a) The program site shall be clean, safe, sanitary and in good repair at all times for the safety and well-being of clients, employees and visitors. (3) Disinfectants, cleaning solutions, poisons, and other items which could pose a danger if readily available to clients shall be stored where inaccessible to clients.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, the licensee did not comply with the section cited above by having an unlocked kitchen cabinet which contained chemicals which poses an immediate health and safety risk to persons in care.
POC Due Date: 02/13/2025
Plan of Correction
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STAFF LOCKED THE CABNET DURING THE VISIT DEFICIENCY CLEARED.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Bennett Fong
LICENSING EVALUATOR NAME:Carol Fowler
LICENSING EVALUATOR SIGNATURE:
DATE: 02/12/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/12/2025


LIC809 (FAS) - (06/04)
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