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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 019201119
Report Date: 02/24/2022
Date Signed: 02/24/2022 06:13:38 PM

Document Has Been Signed on 02/24/2022 06:13 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:ABOVE & BEYOND RCFE, INC.FACILITY NUMBER:
019201119
ADMINISTRATOR:LEANO, ALBERTFACILITY TYPE:
740
ADDRESS:23652 NEVADA ROADTELEPHONE:
(510) 821-0871
CITY:HAYWARDSTATE: CAZIP CODE:
94541
CAPACITY: 6CENSUS: 5DATE:
02/24/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
03:10 PM
MET WITH:Leticia 'Lettie' Velasco/Applicant
and Albert Leano/Administrator		TIME COMPLETED:
06:20 PM
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Licensing Program Analyst (LPA) Delmundo conducted an announced Component III Training via Teams Meeting. Component III was attended by Leticia 'Lettie' Velasco, applicant, and Albert Leano, administrator.

LPA presented the training via Power Point presentation and had a discussion with applicant and administrator.

After Component III, LPA conducted Proof of Correction visit and observed the yard cleaned. LPA also observed the central storage for medications, staff room and cabinet for knives, and cabinets in the garage where cleaning supplies are kept were locked. Applicant submitted copies of in-service training and N95 fit testing record on February 22, 2022.

Exit interview conducted and copy of this report provided.
SUPERVISORS NAME: Bennett Fong
LICENSING EVALUATOR NAME: Alicia Delmundo
LICENSING EVALUATOR SIGNATURE: DATE: 02/24/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/24/2022
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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