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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 079201094
Report Date: 03/29/2024
Date Signed: 03/29/2024 11:40:52 AM

Document Has Been Signed on 03/29/2024 11:40 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 ASC, 1515 CLAY STREET, STE. 310
OAKLAND, CA 94612
FACILITY NAME:WORKING WONDERSFACILITY NUMBER:
079201094
ADMINISTRATOR:SCHWAB, CHRISTINEFACILITY TYPE:
775
ADDRESS:150 MIDDLEFIELD CT SUITE FTELEPHONE:
(925) 331-7797
CITY:BRENTWOODSTATE: CAZIP CODE:
94513
CAPACITY: 24CENSUS: 18DATE:
03/29/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
11:10 AM
MET WITH:Christine Schawb Program DirectorTIME COMPLETED:
11:45 AM
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On 03/29/2024 at 11:10AM Licensing Program Analysts (LPAs) L. Hall and T. Syess-Gibson conducted an unannounced Case Management visit regarding an incident that was reported to CCLD on 03/06/2024. LPAs met with Program Director Christine Schwab and explained the purpose of the visit.

The incident that was reported CCLD occured on 3/5/2024, regarding an AWOL. S1 stated that C1 left the facility through the front door after returning from the gym. C1 returned to the gym, staff was contacted by gym staff that C1 was there. Facility staff went and picked up C1 and notified responsible party. LPAs reviewed physician report that stated C1 is able to leave unassisted. LPAs also obtained C1's individual program plan (IPP)

No deficiencies issued during the visit.

Exit interview conducted and a copy of this report was provided.
SUPERVISORS NAME: Harpreet Humpal
LICENSING EVALUATOR NAME: Tonica Syess-Gibson
LICENSING EVALUATOR SIGNATURE: DATE: 03/29/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/29/2024
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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