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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 019200237
Report Date: 01/27/2023
Date Signed: 01/27/2023 01:38:50 PM

Document Has Been Signed on 01/27/2023 01:38 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:GARDEN TRI-VALLEYFACILITY NUMBER:
019200237
ADMINISTRATOR:HEATHER TAYLOR/WILL SANFORFACILITY TYPE:
775
ADDRESS:676 & 690 L STREETTELEPHONE:
(925) 284-3240
CITY:LIVERMORESTATE: CAZIP CODE:
94551
CAPACITY: 20CENSUS: 10DATE:
01/27/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
11:45 AM
MET WITH:Ciara Vasquez, Program CoordinatorTIME COMPLETED:
01:45 PM
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On 1/10/2023 at 10:35AM, Licensing Program Analyst (LPA) G. Luk arrived unannounced to conduct an Infection Control Inspection. LPA knocked on the door and rang the doorbell with no response. Facility was closed due to weather conditions and no staff was able to meet LPA at the facility.

On 1/27/2023 at 11:45AM, Licensing Program Analyst (LPA) G. Luk arrived unannounced to conduct an Infection Control Inspection. LPA met with staff, Chris Danan. Program Coordinator, Ciara Vasquez arrived 40 minutes later.

Upon entry, LPA's temperature was checked and LPA completed COVID questionnaire online. LPA observed hand sanitizer at screening station. LPA toured facility including but not limited to bathrooms, kitchen, common areas, and outdoor areas. LPA observed cough etiquette, signs & symptoms, and physical distancing are posted in the common areas. All sinks were equipped with soap and paper towel. Hand washing posters were posted at sinks and bathrooms.

During record review, LPA observed visitors log and temperature log was submitted online. LPA observed facility has a copy of Mitigation Plan on file. LPA observed staff have completed fit testing and provided documentation. LPA observed PPE and paper supplies are sufficient.

No deficiencies are being cited on this date.

Exit interview conducted and a copy of this report provided.
SUPERVISORS NAME: Harpreet Humpal
LICENSING EVALUATOR NAME: Grace Luk
LICENSING EVALUATOR SIGNATURE: DATE: 01/27/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/27/2023
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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