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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 015601507
Report Date: 01/09/2024
Date Signed: 01/09/2024 04:08:28 PM


Document Has Been Signed on 01/09/2024 04:08 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:OAKCREEKFACILITY NUMBER:
015601507
ADMINISTRATOR:ROSELINE R. PRASADFACILITY TYPE:
740
ADDRESS:6127 E. CASTRO VALLEY BLVD.TELEPHONE:
(510) 889-7515
CITY:CASTRO VALLEYSTATE: CAZIP CODE:
94552
CAPACITY:38CENSUS: 28DATE:
01/09/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
01:30 PM
MET WITH:Larissa Muresan, Resident Care CoordinatorTIME COMPLETED:
04:20 PM
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On 1/09/2024 Licensing Program Analyst (LPA) K. Nguyen arrived unannounced to conduct 1-Year Annual Required inspection. LPA met with Resident Care Coordinator, Larissa Muresan and explained the purpose of the visit. The facility’s fire clearance was approved for 38 Non-Ambulatory.

The required annual inspection is incomplete and LPA will return to complete inspection at a later date.

No deficiencies cited during visit. Exit interview conducted and a copy of this report provided via email.
SUPERVISOR'S NAME: Bennett FongTELEPHONE: (510) 725-7919
LICENSING EVALUATOR NAME: Kelly NguyenTELEPHONE: (510) 915-8702
LICENSING EVALUATOR SIGNATURE:
DATE: 01/09/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/09/2024
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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