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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 079201403
Report Date: 10/15/2024
Date Signed: 10/15/2024 01:47:24 PM

Document Has Been Signed on 10/15/2024 01:47 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:OAKLEY PLACE LLCFACILITY NUMBER:
079201403
ADMINISTRATOR/
DIRECTOR:		ALDAY, NICOHFACILITY TYPE:
735
ADDRESS:4400 BLANC COURTTELEPHONE:
(650) 745-5026
CITY:OAKLEYSTATE: CAZIP CODE:
94561
CAPACITY: 4CENSUS: 0DATE:
10/15/2024
TYPE OF VISIT:PrelicensingANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:25 AM
MET WITH:Nicoh Alday, AdministratorTIME VISIT/
INSPECTION COMPLETED:
12:36 PM
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On 10/15/2024 at 10:25AM, Licensing Program Analysts (LPA) T. Syess-Gibson arrived announced to conduct Pre-licensing Inspection. Upon arrival, LPA met with Nicoh Alday, Administrator, and explained the purpose of the visit. The facility currently has no clients.

LPA toured facility including but not limited to four (4) bedrooms, two (2) baths , kitchen, common areas and backyard. Bedrooms and living rooms were equipped with the proper furniture and hygiene supplies were observed. During the tour LPA observed there wasn't enough linen for clients.

LPA observed There wasn't 7 days of non perishables and 2 days of perishables. LPA observed facility has no land line telephone installed. There is sufficient lighting throughout facility. Room temperature was maintained at 75 degrees F and hot water temperature was maintained at 115.5 degrees F. First-Aid kit was observed to be complete. Smoke detectors and carbon monoxide were operational. Fire extinguisher was last serviced on 06/06/2024.

Component III will be conducted during next visit .


Continue on LIC809C
SUPERVISORS NAME: Harpreet Humpal
LICENSING EVALUATOR NAME: Tonica Syess-Gibson
LICENSING EVALUATOR SIGNATURE: DATE: 10/15/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/15/2024
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 2
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: OAKLEY PLACE LLC
FACILITY NUMBER: 079201403
VISIT DATE: 10/15/2024
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Continue from LIC809


The following items must be corrected prior to licensing:
  • A sufficient supply of clean linens to permit weekly changing or more of client top
sheets, bottom sheets, bedspreads, blankets, pillowcases, mattress covers, bath towels,
hand towels, and washcloths.
  • A seven (7) day supply of non-perishable food and 2 days of perishables
  • Completed Personnel Files for Administrator/Licensee .
  • There is an operating telephone available to clients



Exit interview conducted and a copy of this report provided.

SUPERVISORS NAME: Harpreet Humpal
LICENSING EVALUATOR NAME: Tonica Syess-Gibson
LICENSING EVALUATOR SIGNATURE:

DATE: 10/15/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/15/2024
LIC809 (FAS) - (06/04)
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