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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 079201301
Report Date: 05/20/2024
Date Signed: 05/20/2024 12:49:52 PM

Document Has Been Signed on 05/20/2024 12:49 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:UNION ALLIANCEFACILITY NUMBER:
079201301
ADMINISTRATOR/
DIRECTOR:		RILES, CHARLOTTEFACILITY TYPE:
735
ADDRESS:1667 BEDFORD COURTTELEPHONE:
(510) 440-7005
CITY:BRENTWOODSTATE: CAZIP CODE:
94513
CAPACITY: 6CENSUS: 0DATE:
05/20/2024
TYPE OF VISIT:PrelicensingANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:40 AM
MET WITH:Charolette Riles Licensee/Administrator TIME VISIT/
INSPECTION COMPLETED:
12:50 PM
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On 5/13/2024 at 10:40AM, Licensing Program Analyst (LPA) T. Syess-Gibson conducted an announced pre-licensing inspection. LPA met with Charlotte Riles, License/Administrator, and explained the purpose of the visit. The facility has an approved fire safety clearance for six (6) ambulatory clients.

LPA inspected the facility inside and out including but not limited to the bedrooms, bathrooms, common living areas, kitchen, garage, back yard. The facility has a total of four (4) bedrooms and two and one-half (2 1/2) bathrooms. LPA observed a pool in the backyard surrounded with a locked gate. There is sufficient lighting around the facility. Clients rooms are equipped with the proper furniture, bedding, and lighting. Passageways and hallways are free of obstruction. Locked cabinets available to store medications, toxins and sharps. Hot water temperature is measured at 125.9 degrees Fahrenheit in shared clients' bathroom. Fire extinguisher was last purchased on 8/27/2023. There is a minimum of 7-day non-perishables and 2-day perishables foods. First Aid kit was complete. Carbon monoxide and smoke detectors present.

No Issues were 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 Administrator and a copy of this report provided.
SUPERVISORS NAME: Harpreet Humpal
LICENSING EVALUATOR NAME: Tonica Syess-Gibson
LICENSING EVALUATOR SIGNATURE: DATE: 05/20/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/20/2024
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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