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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 019201472
Report Date: 01/29/2025
Date Signed: 01/29/2025 01:16:27 PM

Document Has Been Signed on 01/29/2025 01:16 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:OUR THREE HEARTS CARE HOME LLCFACILITY NUMBER:
019201472
ADMINISTRATOR/
DIRECTOR:		LABRADOR, EDWARDFACILITY TYPE:
740
ADDRESS:35459 CLEREMONT DRIVETELEPHONE:
(341) 249-4800
CITY:NEWARKSTATE: CAZIP CODE:
94560
CAPACITY: 6CENSUS: 0DATE:
01/29/2025
TYPE OF VISIT:PrelicensingANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:20 AM
MET WITH:Edward Labrador, Administrator TIME VISIT/
INSPECTION COMPLETED:
11:40 AM
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On 01/29/2025 at 10:20 AM, Licensing Program Analysts (LPAs) P. Manalo and L. Fontanilla arrived announced to conduct pre licensing inspection. LPAs met with Administrator, Edward Labrador, and explained the purpose of the visit. The facility currently has no residents.

LPA toured facility with the Administrator including but not limited to 5 bedrooms, 2 bathrooms, kitchen, common areas and backyard. Bathrooms were equipped with grab bars and non-skid mats. Linens and hygiene supplies were observed inside a cabinet. There is sufficient lighting throughout facility. Room temperature was maintained at 68 degrees Fahrenheit and hot water temperature was maintained at 105.7 degrees Fahrenheit. First-aid kit was observed to be complete. Smoke detectors and carbon monoxide were operational and are interconnected. Fire extinguishers were last serviced on 10/23/2024. The facility has a working telephone that was verified during the visit.

Prior to licensure, the following shall be corrected and emailed to CCLD by 02/12/2025:

Bedroom #1 and Bedroom #4 need a chest dresser.

The backyard fence needs to be repaired.

The bedroom doors do not have identifying numbers for each room.

The side exit gate has a second sliding bolt that needs to be removed.

Exit interview was conducted and a copy of this report was provided to Licensee/applicant.
SUPERVISORS NAME: Yvonne Flores-Larios
LICENSING EVALUATOR NAME: Patricia Manalo
LICENSING EVALUATOR SIGNATURE: DATE: 01/29/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/29/2025
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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