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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 015601283
Report Date: 03/09/2022
Date Signed: 03/09/2022 04:16:30 PM


Document Has Been Signed on 03/09/2022 04:16 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:PARKVIEW, THEFACILITY NUMBER:
015601283
ADMINISTRATOR:ZAININGER, SYLVIAFACILITY TYPE:
740
ADDRESS:100 VALLEY AVETELEPHONE:
(925) 461-3042
CITY:PLEASANTONSTATE: CAZIP CODE:
94566
CAPACITY:123CENSUS: 99DATE:
03/09/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
01:45 PM
MET WITH:Aireen Tibon, Executive DirectorTIME COMPLETED:
04:30 PM
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On 3/9/2022 at 1:45PM, Licensing Program Analyst (LPA) G. Luk arrived unannounced to conduct an Infection Control Inspection. LPA met with Executive Director, Aireen Tibon.

Upon entry, LPA was asked to complete the automated system for COVID-19 screening. LPA observed hand sanitizer at screening station. LPA toured facility including but not limited to resident's bedrooms, bathrooms, kitchen, common areas, and outdoor areas. LPA observed cough etiquette, signs & symptoms, and physical distancing are posted in the common areas. All hand washing stations were equipped with soap and paper towel. Hand washing posters were posted in bathrooms. Smoke and carbon monoxide detectors observed. Indoor and outdoor passageways are free of obstruction.

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

No deficiencies are being cited on this date.

Exit interview conducted. A copy of this report was provided.
SUPERVISOR'S NAME: Harpreet HumpalTELEPHONE: (510) 285-3928
LICENSING EVALUATOR NAME: Grace LukTELEPHONE: (510) 286-4201
LICENSING EVALUATOR SIGNATURE:
DATE: 03/09/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/09/2022
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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