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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 019201399
Report Date: 10/22/2024
Date Signed: 10/22/2024 12:16:52 PM

Document Has Been Signed on 10/22/2024 12:16 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:ESSENTIALS CREST LANE CARE HOMEFACILITY NUMBER:
019201399
ADMINISTRATOR/
DIRECTOR:		SARMIENTO, PAMELAFACILITY TYPE:
740
ADDRESS:32262 CREST LANETELEPHONE:
(510) 861-8705
CITY:UNION CITYSTATE: CAZIP CODE:
94587
CAPACITY: 6CENSUS: 0DATE:
10/22/2024
TYPE OF VISIT:PrelicensingANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:00 AM
MET WITH:Pamela Sarmiento, AdministratorTIME VISIT/
INSPECTION COMPLETED:
12:30 PM
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On 10/22/2024 at 09:00 AM, Licensing Program Analysts (LPAs) J. Sampair and D. Doidge arrived announced to conduct a Prelicensing inspection. Upon entry into the facility, the LPAs informed Administrator Pamela Sarmiento and Ronaldo Deleon of the purpose of the visit.

The LPAs toured the facility, inspecting the kitchen, common areas, bedrooms, bathrooms, and the exterior of the facility. The facility was clean, appropriately furnished, and well lit. More than the 2 days of perishable and 7 days of nonperishable food supplies were available. Facility included a locking cabinet for centrally stored medications. Personnel and facility records were stored at the facility and made accessible to the LPAs. Bathrooms and showers were observed to be fully functioning and clean. Carbon monoxide and smoke detectors operational and the fire extinguishers were last serviced on 06/21/2024.

The facility did pass the pre-licensing inspection.

Component III training completed.

Exit interview conducted and a copy of this report provided to the applicant.
SUPERVISORS NAME: Bennett Fong
LICENSING EVALUATOR NAME: David Doidge
LICENSING EVALUATOR SIGNATURE: DATE: 10/22/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/22/2024
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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