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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 079201094
Report Date: 09/19/2024
Date Signed: 09/19/2024 02:49:27 PM

Document Has Been Signed on 09/19/2024 02:49 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:WORKING WONDERSFACILITY NUMBER:
079201094
ADMINISTRATOR/
DIRECTOR:		SCHWAB, CHRISTINEFACILITY TYPE:
775
ADDRESS:150 MIDDLEFIELD CT SUITE FTELEPHONE:
(925) 331-7797
CITY:BRENTWOODSTATE: CAZIP CODE:
94513
CAPACITY: 24CENSUS: 21DATE:
09/19/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:20 PM
MET WITH:Christine Schwab, Administrator/DirectorTIME VISIT/
INSPECTION COMPLETED:
03:23 PM
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On 09/19/2024 at 1:20pm, Licensing Program Analyst (LPA) T. Syess-Gibson arrived unannounced to conduct an Annual 1-Year required inspection. LPA met with Christine Schwab, Administrator/ Director, and explained the reason for the visit. The facility's fire clearance was approved for twenty two (22) ambulatory and two (2) non-ambulatory clients

LPA inspected the facility with Melanie Tita, Supervisor, which included but not limited to the bathrooms, kitchen, activity room and common areas of the facility. LPA observed the facility to be free of odor, clean and in good repair. There is a comfortable room temperature of 74 degrees Fahrenheit for clients in care. Clients bring their own lunches and snacks to facility. The hot water temperature in the shared bathroom measured 104.6 degrees. All observed toilets and hand washing stations are maintained in a safe, sanitary, operating condition. There are no bodies of water or fire safety hazards observed. Carbon monoxide and smoke detectors found to be in working order. No medications are administered at the facility, toxins and sharp objects were locked and inaccessible to clients. Emergency disaster plan last updated 05/28/2024. Fire extinguisher last services 03/17/2024. Fire drill last conducted 08/06/2024. First aid kit was checked and is complete.

LPA reviewed five (5) staff files. LPA reviewed five (5) clients, and all were current and complete.

Continued LIC809C.
SUPERVISORS NAME: Harpreet Humpal
LICENSING EVALUATOR NAME: Tonica Syess-Gibson
LICENSING EVALUATOR SIGNATURE: DATE: 09/19/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/19/2024
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
OAKLAND ASC, 1515 CLAY STREET, STE. 310
OAKLAND, CA 94612
FACILITY NAME: WORKING WONDERS
FACILITY NUMBER: 079201094
VISIT DATE: 09/19/2024
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Continued from LIC809.

The following forms to be updated and submitted to CCLD by 09/26/2024:

· LIC 308 Designation of Administrative Responsibility
· LIC 610D Emergency Disaster Plan

LPAs observed no deficiencies during visit.

Exit interview conducted. A copy of this report provided.
SUPERVISORS NAME: Harpreet Humpal
LICENSING EVALUATOR NAME: Tonica Syess-Gibson
LICENSING EVALUATOR SIGNATURE:

DATE: 09/19/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/19/2024
LIC809 (FAS) - (06/04)
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