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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 015601398
Report Date: 11/09/2023
Date Signed: 11/09/2023 02:29:44 PM


Document Has Been Signed on 11/09/2023 02:29 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 GARDEN 2FACILITY NUMBER:
015601398
ADMINISTRATOR:ALICIA PEACOCKFACILITY TYPE:
740
ADDRESS:836 SOUTH J STREETTELEPHONE:
(925) 872-2705
CITY:LIVERMORESTATE: CAZIP CODE:
94550
CAPACITY:6CENSUS: 3DATE:
11/09/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Alicia Johnston, AdministratorTIME COMPLETED:
02:00 PM
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On 11/9/2023 at 10:00AM, Licensing Program Analyst (LPA) G. Luk arrived unannounced to conduct a Required - 1 Year inspection. LPA met with Caregiver, Angela Dela Cruz and informed her the reason for the visit. Administrator, Alicia Johnston arrived 15 minutes later.

LPA toured the facility with Alicia including but not limited to bedrooms, bathrooms, dining area, kitchen, common areas, garage, and outdoor area. Smoke and carbon monoxide detectors were 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. One week supply of nonperishable and 2-day supply of perishable foods were available. Centrally stored medications were locked in the cabinet in the kitchen area. First Aid kit is complete. The facility has a written emergency disaster plan. Indoor and outdoor passages were free of obstruction. Last disaster drill was conducted on 10/15/2023.

LPA reviewed 3 resident and 3 staff files starting at 11:15AM. LPA reviewed a sample of resident's medications starting at 12:45PM. LPA interviewed 2 residents and 2 staff starting at 1:30PM.

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: 11/09/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/09/2023
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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