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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 015600304
Report Date: 08/21/2024
Date Signed: 08/21/2024 02:13:43 PM


Document Has Been Signed on 08/21/2024 02:13 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:QUAIL GARDENFACILITY NUMBER:
015600304
ADMINISTRATOR:PEACOCK, ALICIAFACILITY TYPE:
740
ADDRESS:813 SOUTH J STREETTELEPHONE:
(925) 449-4411
CITY:LIVERMORESTATE: CAZIP CODE:
94550
CAPACITY:20CENSUS: 15DATE:
08/21/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Alicia Johnston, AdministratorTIME COMPLETED:
02:20 PM
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On 8/21/2024 at 9:30AM, Licensing Program Analyst (LPA) G. Luk arrived unannounced to conduct a Required - 1 Year inspection. LPA met with Administrator, Alicia Johnston and explained the purpose of the visit.

LPA toured the facility with Alicia including but not limited to bedrooms, bathrooms, dining area, activity rooms, kitchen, common areas, and outdoor area. Smoke detectors were interconnected with sprinkler system. Carbon monoxide detector was observed. Fire extinguishers were observed to be full and last serviced on 11/9/2023. There were adequate lights in each room. Grab bars and non-skid mats were observed. Hot water temperature was measured at 111.7 degrees F. One week supply of nonperishable and 2-day supply of perishable foods were available. Freezer’s temperature was registered at 0 degree F while the refrigerator’s temperature was recorded at 38 degrees F. Centrally stored medications were locked in the cabinet behind the front desk. First Aid kit is complete. The facility has a written emergency disaster plan. Last disaster drill was conducted on 7/15/2024.

LPA reviewed 3 resident and 3 staff files starting at 11:00AM. LPA interviewed 3 residents and 3 staff during inspection. LPA reviewed a sample of resident's medications at around 12:00PM.

No deficiencies are being cited on this date.

Exit interview conducted. A copy of this report provided.
SUPERVISOR'S NAME: Harpreet HumpalTELEPHONE: (510) 285-3928
LICENSING EVALUATOR NAME: Grace LukTELEPHONE: (510) 286-4201
LICENSING EVALUATOR SIGNATURE:
DATE: 08/21/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/21/2024
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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