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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 015600118
Report Date: 04/24/2024
Date Signed: 04/24/2024 04:53:45 PM

Document Has Been Signed on 04/24/2024 04:53 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:CARLTON PLAZA OF FREMONTFACILITY NUMBER:
015600118
ADMINISTRATOR/
DIRECTOR:		GEUL, MEGHIAN EFACILITY TYPE:
740
ADDRESS:3800 WALNUT AVENUETELEPHONE:
(510) 505-0555
CITY:FREMONTSTATE: CAZIP CODE:
94538
CAPACITY: 128CENSUS: 126DATE:
04/24/2024
TYPE OF VISIT:Case Management - Annual ContinuationUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:00 AM
MET WITH:Meghian Geul, Executive DirectorTIME VISIT/
INSPECTION COMPLETED:
05:00 PM
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On 4/24/2024 at 10:00AM, Licensing Program Analyst (LPA) G. Luk arrived unannounced to conduct Case Management - Annual Continuation. LPA met with Executive Director, Meghian Geul and explained the purpose of the visit.

During visit, LPA reviewed 7 residents' files and 7 staff files. LPA observed resident's files were complete and staff files were complete. Staff have current first aid and CPR training. LPA observed staff completed training which includes dementia, food service, resident rights, medication, ADL (Activities of Daily Living) care, and other topics. Last fire drill was conducted on 3/28/2024.

LPA reviewed a sample of resident's medications at around 3:30PM. LPA interviewed 5 residents and 5 staff starting at 2:00PM.

No deficiencies are being cited on this date.

Exit interview conducted. A copy of this report were provided.
SUPERVISORS NAME: Harpreet Humpal
LICENSING EVALUATOR NAME: Grace Luk
LICENSING EVALUATOR SIGNATURE: DATE: 04/24/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/24/2024
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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