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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 015601283
Report Date: 02/19/2025
Date Signed: 02/19/2025 05:49:19 PM

Document Has Been Signed on 02/19/2025 05:49 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/
DIRECTOR:
TIBON, AIREENFACILITY TYPE:
740
ADDRESS:100 VALLEY AVETELEPHONE:
(925) 461-3042
CITY:PLEASANTONSTATE: CAZIP CODE:
94566
CAPACITY: 123TOTAL ENROLLED CHILDREN: 0CENSUS: 97DATE:
02/19/2025
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:45 AM
MET WITH:Sherallyn Dones, Resident Care CoordinatorTIME VISIT/
INSPECTION COMPLETED:
06:00 PM
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On 2/19/2025 at 9:45AM, Licensing Program Analyst (LPA) G. Luk arrived unannounced to conduct a Required - 1 Year inspection. LPA met with Resident Care Coordinator, Sherallyn Dones and explained the reason for the visit.

LPA toured the facility including but not limited to bedrooms, bathrooms, dining area, kitchen, activity rooms, common areas, and outdoor area. Centrally stored medications were locked in medication carts located in med rooms. First Aid kit is complete. The facility has a written emergency disaster plan. Smoke detectors were interconnected with sprinkler system. Carbon monoxide detectors were observed. Fire extinguishers were observed to be full and last serviced on 3/25/2024.

One week of nonperishable and 2-day of perishable food supplies were available. Facility orders food twice a week. Freezer’s temperature was registered at 0 degree F while the refrigerator’s temperature was recorded at 40 degrees F. Hot water temperature was measured at 120 degrees F in a resident's bathroom. Grab bars for each toilet and shower were installed. Non-skid mats were observed. There were adequate lights in each room. Resident rooms were observed to be cleaned and fully furnished. Indoor and outdoor passages were free of obstruction.

During visit, LPA reviewed 5 residents and 5 staff files. LPA observed staff completed annual training. LPA reviewed a sample of resident's medications during inspection.

No deficiencies are being cited on this date.

Exit interview conducted. A copy of this report provided.
Harpreet HumpalTELEPHONE: (510) 285-3928
Grace LukTELEPHONE: (510) 286-4201
DATE: 02/19/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/19/2025
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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