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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 015201935
Report Date: 01/23/2023
Date Signed: 01/23/2023 12:43:26 PM

Document Has Been Signed on 01/23/2023 12:43 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: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:
01/23/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Karen Sangco, AdministratorTIME COMPLETED:
10:30 AM
NARRATIVE
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On 1/23/2023 at 9:00AM, 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. Hot water was measured at 110.5 degrees F in the hallway bathroom.

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.

LPA observed facility did not have a current copy of LIC610D completed.

The deficiency was observed (see LIC 809D) and cited from the California Code of Regulation, Title 22. Failure to correct the deficiency may result in civil penalties.

Exit interview conducted. A copy of this report and appeal rights provided.
SUPERVISORS NAME: Harpreet Humpal
LICENSING EVALUATOR NAME: Grace Luk
LICENSING EVALUATOR SIGNATURE: DATE: 01/23/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/23/2023
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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Document Has Been Signed on 01/23/2023 12:43 PM - It Cannot Be Edited


Created By: Grace Luk On 01/23/2023 at 10:46 AM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 1515 CLAY STREET, STE. 310
OAKLAND, CA 94612

FACILITY NAME: REGENT HOME
FACILITY NUMBER: 015201935

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/23/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
80023(a)
Disaster & Mass Casualty Plan
(a) Each licensee shall have and maintain on file a current, written disaster and mass casualty plan of action.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review, the licensee did not comply with the section cited above by not completed the new LIC610D which poses a potential health and safety risk to persons in care.
POC Due Date: 01/30/2023
Plan of Correction
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Administrator has agreed to complete the new LIC610D and submit a copy to CCLD by POC date.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Harpreet Humpal
LICENSING EVALUATOR NAME:Grace Luk
LICENSING EVALUATOR SIGNATURE:
DATE: 01/23/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/23/2023


LIC809 (FAS) - (06/04)
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