<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 019200141
Report Date: 01/14/2025
Date Signed: 01/14/2025 12:15:46 PM

Document Has Been Signed on 01/14/2025 12:15 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:PARKWAY VILLAGE CARE HOME, INC.FACILITY NUMBER:
019200141
ADMINISTRATOR/
DIRECTOR:		JACQUELINE SANTOSFACILITY TYPE:
735
ADDRESS:183 HERMES COURTTELEPHONE:
(510) 586-0547
CITY:HAYWARDSTATE: CAZIP CODE:
94544
CAPACITY: 6CENSUS: 6DATE:
01/14/2025
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:20 AM
MET WITH:Jacqueline Santos, Administrator TIME VISIT/
INSPECTION COMPLETED:
12:35 PM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
On 1/14/2025, at 9:20 AM, Licensing Program Analyst (LPA) K. Nguyen arrived unannounced to conduct a 1-year requirement annual visit. LPA was greeted by Jacqueline Santos, Administrator (ADM) and explained the purpose of the visit.

During the inspection, LPA toured facility including but not limited to front entrance, kitchen, common areas, hand washing stations, bedrooms, bathrooms, and backyard. Facility has a sufficient 2-day perishable and 7-days non-perishable food supply. All sharps and toxins were locked up and inaccessible to clients in care. Common areas are disinfected frequently throughout the day. Water temperature is measured at 108 Degrees F. Fire extinguisher was last serviced on 1/29/2024 observed to be fully charge. Facilities room temperature is maintained at 68 Degrees F. First aid kit is complete. Carbon monoxide and smoke detectors are functional. Facility passages inside and out are free of obstruction and does not pose a health and safety risk for persons in care. Fire Drill was last conducted on 12/8/2024. Disaster plan was last updated and posted on 1/14/2025.

LPA reviewed 6 clients files and 3 staff records. 3 out of 3 have current CPR/ First Aid on files.



No deficiencies cited during today's visit.

Exit interview conducted with Administrator and copy of this report provided.
SUPERVISORS NAME: Bennett Fong
LICENSING EVALUATOR NAME: Kelly Nguyen
LICENSING EVALUATOR SIGNATURE: DATE: 01/14/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/14/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 1