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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 019200248
Report Date: 02/23/2024
Date Signed: 02/23/2024 03:00:49 PM

Document Has Been Signed on 02/23/2024 03:00 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:BLESSED BE CARE HOMEFACILITY NUMBER:
019200248
ADMINISTRATOR:LALLIE VALENCIAFACILITY TYPE:
735
ADDRESS:31346 SANTA ELENA WAYTELEPHONE:
(510) 324-8562
CITY:UNION CITYSTATE: CAZIP CODE:
94587
CAPACITY: 6CENSUS: 6DATE:
02/23/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:50 AM
MET WITH:Lallie ValenciaTIME COMPLETED:
03:10 PM
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On this day at around 10:50 am, Licensing Program Analyst (LPA) Luisa Fontanilla arrived unannounced to conduct an annual required inspection. LPA was met by staff Pricila Rivera. The Administrator was informed and arrived at the facility at around 11am.

LPA inspected the facility inside and out including but not limited to client rooms, bathrooms, dining, kitchen, garage, sun room and backyard. Hot water measured at 109 degrees Fahrenheit in the kitchen and bathroom. Facility was observed clean and odor free. There were no bodies of water observed. Sharps, chemicals and medications were observed locked in different cabinets. There was sufficient supply of perishable and non perishable foods. Fire extinguisher was observed full and was last serviced on 7/6/2023. Carbon monoxide and smoke detectors were tested and observed functional. First aid kit was observed complete. Last fire drill was conducted on .

At 12:05 pm, LPA reviewed 5 client files and 5 staff files. Staff are all fingerprint cleared and associated to the facility. They have current first aid and CPR training. At around 1:45 pm , LPA verified P & I money and log. The facility has surety bond sufficient to cover amount of cash being handled at one time.

At 2:10 pm, LPA interviewed 2 staff and 2 clients.

There is no deficiency noted for this visit.

Exit interview was conducted with Administrator and a copy of this report was provided.


SUPERVISORS NAME: Yvonne Flores-Larios
LICENSING EVALUATOR NAME: Luisa Fontanilla
LICENSING EVALUATOR SIGNATURE: DATE: 02/23/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/23/2024
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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