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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 079201403
Report Date: 10/24/2024
Date Signed: 10/24/2024 03:17:51 PM

Document Has Been Signed on 10/24/2024 03:17 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:
10/24/2024
TYPE OF VISIT:PrelicensingANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
02:15 PM
MET WITH:Nicoh Alday, AdministratorTIME VISIT/
INSPECTION COMPLETED:
03:33 PM
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On 10/24/2024 at 2:15PM, Licensing Program Analyst (LPA) T.Syess-Gibson conducted an announced pre-licensing continuance inspection. LPA met with Nicoh Alday, License/Administrator, and explained the purpose of the visit. The facility has an approved fire safety clearance for four (4) 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 (2) bathrooms. No bodies of water observed. There is sufficient lighting around the facility. Clients’ rooms are equipped with the proper furniture, bedding, and lighting. Bathrooms showers/tubs were equipped with non skid mats. Passageways and hallways are free of obstruction. Locked cabinets available to store medications, toxins and sharps. Hot water temperature is measured at 115.5 degrees Fahrenheit in shared clients' bathroom. Fire extinguisher was last purchased on 06/06/2024.. 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. Facility inspection matches the sketch that was provided. LPA observed all corrections were made from previous visit on 10/15/2024.

A Component III was also completed during the Pre-licensing continuance inspection on 10/24/2024 with Administrator Nicoh Alday. The applicant was reminded of the statute that requires CCL to be notified within 5 business days of admitting their first client. This notification may be done by phone, by mail, or by fax.

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: 10/24/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/24/2024
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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