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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 015201935
Report Date: 04/01/2022
Date Signed: 04/01/2022 10:09:23 AM

Document Has Been Signed on 04/01/2022 10:09 AM - 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:REGENT HOMEFACILITY NUMBER:
015201935
ADMINISTRATOR:SANGCO, KAREN L.FACILITY TYPE:
734
ADDRESS:2508 REGENT ROADTELEPHONE:
(925) 371-5274
CITY:LIVERMORESTATE: CAZIP CODE:
94550
CAPACITY: 5CENSUS: 5DATE:
04/01/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
08:35 AM
MET WITH:Karen Sangco, AdministratorTIME COMPLETED:
10:20 AM
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On 4/1/2022 at 8:35AM, Licensing Program Analyst (LPA) G. Luk arrived unannounced to conduct an Infection Control Inspection. LPA met with Administrator, Karen Sangco and explained the purpose of the visit.

Upon entry, LPA's temperature was checked and asked screening questions. LPA observed hand sanitizer at screening station and hand washing station located outside next to front door. LPA toured facility including but not limited to bedrooms, bathroom, kitchen, common areas, garage, and outdoor areas. LPA observed cough etiquette, physical distancing, and signs & symptoms posted in the common areas. All hand washing stations were equipped with soap, paper towel, and garbage with a lid. Hand washing posters were posted at bathrooms and sinks.

During record review, LPA observed visitors log and temperature log for both staff and clients. LPA observed facility has a copy of Mitigation Plan on file. Staff were Fit tested and certificate cards were observed. LPA observed PPE, food, and paper supplies are sufficient.

No deficiencies are being cited today.

Exit interview conducted. A copy of this report provided.
SUPERVISORS NAME: Harpreet Humpal
LICENSING EVALUATOR NAME: Grace Luk
LICENSING EVALUATOR SIGNATURE: DATE: 04/01/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/01/2022
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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