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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 079201260
Report Date: 05/09/2023
Date Signed: 05/09/2023 09:42:20 AM

Document Has Been Signed on 05/09/2023 09:42 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
CCLD Regional Office, 1515 CLAY STREET, STE. 310
OAKLAND, CA 94612
FACILITY NAME:ACQUIRED LIVING LLCFACILITY NUMBER:
079201260
ADMINISTRATOR:BOATNER, SALINAFACILITY TYPE:
735
ADDRESS:2194 MEGAN DRIVETELEPHONE:
(925) 206-1947
CITY:OAKLEYSTATE: CAZIP CODE:
94531
CAPACITY: 4CENSUS: 0DATE:
05/09/2023
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
09:20 AM
MET WITH:BOATNER, SALINA, Applicant TIME COMPLETED:
09:55 AM
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On 5/9/2023, LPA L. Ibo conducted case management in continuation of the pre-licensing visit from 05/04/2023. LPA observed zero clients.

LPA observed the following items were corrected:
1. Facility needs a secure fence for the body of water (pond/fountain) located at the facility’s backyard

Facility covered the pond/fountain with gravel and sand. Facility do not have body of water observed.

No issues noted during inspection. LPA observed that facility is ready to be licensed. This report will be submitted to the Central Applications Unit (CAU) and a final review of the application will be conducted. This facility is not yet licensed and is subject to final approval by CAU. Additional requirements may still be required.

Exit interview conducted with Applicant Salina Baotner and a copy of report was given.
SUPERVISORS NAME: Harpreet Humpal
LICENSING EVALUATOR NAME: Leslie Ibo
LICENSING EVALUATOR SIGNATURE: DATE: 05/09/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/09/2023
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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