<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 079201248
Report Date: 05/03/2024
Date Signed: 05/03/2024 12:34:48 PM

Document Has Been Signed on 05/03/2024 12:34 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:VALLEY OAK RESPITE CENTERFACILITY NUMBER:
079201248
ADMINISTRATOR/
DIRECTOR:		PEER, GARYFACILITY TYPE:
775
ADDRESS:989 SAN RAMON VALLEY BLVDTELEPHONE:
(925) 915-0030
CITY:DANVILLESTATE: CAZIP CODE:
94526
CAPACITY: 30CENSUS: 30DATE:
05/03/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
11:30 AM
MET WITH:Administrator, Gary PeerTIME VISIT/
INSPECTION COMPLETED:
12:50 PM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
On 5/03/2024 at 11:30 AM, Licensing Program Analyst (LPA) A. Gomez arrived unannounced to conduct 1-Year Annual Required inspection. LPA met with Administrator, Gary Peer and explained the purpose of the visit. Day program operates from 10:30AM to 2:30PM. There were 5 staff observed working with the 22 clients here today.

LPA toured facility with Administrator including but not limited to, multiple activity rooms, kitchen, bathrooms, office space, and the outside recreational area. 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. 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. The facility is free of odors. Reviewed client and staff files for sampling. Emergency disaster drills are conducted quarterly. Fire extinguishers throughout facility were last inspected 12/28/2023. First aid kit was checked. Disaster plan posted.


No deficiencies cited during visit. Exit interview conducted and a copy of this report provided.
SUPERVISORS NAME: Yvonne Flores-Larios
LICENSING EVALUATOR NAME: Alona Gomez
LICENSING EVALUATOR SIGNATURE: DATE: 05/03/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/03/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 1