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Department of
SOCIAL SERVICES
Community Care Licensing
FACILITY EVALUATION REPORT
Facility Number:
079201260
Report Date:
05/04/2023
Date Signed:
05/04/2023 01:57:57 PM
Document Has Been Signed on
05/04/2023 01:57 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:
ACQUIRED LIVING LLC
FACILITY NUMBER:
079201260
ADMINISTRATOR:
BOATNER, SALINA
FACILITY TYPE:
735
ADDRESS:
2194 MEGAN DRIVE
TELEPHONE:
(925) 206-1947
CITY:
OAKLEY
STATE:
CA
ZIP CODE:
94531
CAPACITY:
4
CENSUS:
0
DATE:
05/04/2023
TYPE OF VISIT:
Case Management - Other
UNANNOUNCED
TIME BEGAN:
12:10 PM
MET WITH:
BOATNER, SALINA, Applicant
TIME COMPLETED:
02:15 PM
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On 5/4/2023 LPA L. Ibo conducted case management conducted component III discussion.
The following were discussed and requested to be updated and/or corrected.
1.
Facility needs a secure fence for the body of water (pond/fountain) located at the facility’s backyard
A re-inspection is needed to follow up the secure fence for the body of water.
License is pending final review by CAB analyst.
Copy of this report provided to Salina Boatner. Exit interview conducted and a copy of this report provided.
SUPERVISORS NAME
:
Harpreet Humpal
LICENSING EVALUATOR NAME
:
Leslie Ibo
LICENSING EVALUATOR SIGNATURE
:
DATE:
05/04/2023
I acknowledge receipt of this form and understand my
licensing
appeal rights as
explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE:
05/04/2023
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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