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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 015601201
Report Date: 02/10/2021
Date Signed: 02/10/2021 01:37:27 PM

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:EASY LIVING CARE HOMEFACILITY NUMBER:
015601201
ADMINISTRATOR:GARCIA, EMILY & BENJAMINFACILITY TYPE:
740
ADDRESS:3536 MURPHY STREETTELEPHONE:
(925) 989-3345
CITY:LIVERMORESTATE: CAZIP CODE:
94550
CAPACITY:6CENSUS: 5DATE:
02/10/2021
TYPE OF VISIT:Case Management - OtherANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Mercedes Morales, AdministratorTIME COMPLETED:
01:20 PM
NARRATIVE
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On 2/10/2021 at 10:00AM, Licensing Program Analyst (LPA) G. Luk conducted a Tele-visit Case Management as a result of a change in ownership. Tele-visit was completed via FaceTime due to shelter in place directed by the Governor. LPA spoke with Administrator, Mercedes Morales.

During the Tele-Inspection, LPA toured facility with Administrator including but not limited to resident's bedrooms, bathrooms, living room, dining room, kitchen, and outdoor area.

The following are the deficiencies were found during Pre-Licensing Inspection:

At 10:12AM, LPA observed lighter unlocked in a kitchen drawer. Administrator locked the lighter during inspection.

At 10:18AM, LPA observed R1 has a full bed rail and not on hospice care. Facility removed the full bed rail and replaced it with a half bed rail. Administrator will obtain a physician's order for the half bed rail.

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

Exit interview conducted. A copy of this report and appeal rights will be emailed.
SUPERVISOR'S NAME: Harpreet HumpalTELEPHONE: (510) 285-3928
LICENSING EVALUATOR NAME: Grace LukTELEPHONE: (510) 286-4201
LICENSING EVALUATOR SIGNATURE:

DATE: 02/10/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/10/2021
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

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

FACILITY NAME: EASY LIVING CARE HOME
FACILITY NUMBER: 015601201
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/10/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
02/11/2021
Section Cited

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Storage Space. Disinfectants,... and other items which could pose a danger...shall be stored where inaccessible to clients. This requirement is not met as evidence by:
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Based on observation, facility did not comply with the section cited above by having a lighter unlocked which poses an immediate health and safety risk to the residents in care.
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Type B
02/17/2021
Section Cited

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Postural Supports. Bed rails that extend the entire length of the bed are prohibited except for residents who are currently receiving hospice care... This requirement is not met as evidence by:
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Based on interview, facility did not comply with the section cited above by having a full bed rail for a non hospice resident which poses a potential health and safety risk to the residents in care.
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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 HumpalTELEPHONE: (510) 285-3928
LICENSING EVALUATOR NAME: Grace LukTELEPHONE: (510) 286-4201
LICENSING EVALUATOR SIGNATURE:
DATE: 02/10/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/10/2021
LIC809 (FAS) - (06/04)
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