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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 019200413
Report Date: 05/30/2024
Date Signed: 05/30/2024 12:27:13 PM


Document Has Been Signed on 05/30/2024 12:27 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:KEAN MANORFACILITY NUMBER:
019200413
ADMINISTRATOR:MARJORIE ONGPAUCOFACILITY TYPE:
735
ADDRESS:14825 LARK STREETTELEPHONE:
(510) 352-3000
CITY:SAN LEANDROSTATE: CAZIP CODE:
94578
CAPACITY:4CENSUS: 4DATE:
05/30/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:30 AM
MET WITH:Nemia Atendido, LicenseeTIME COMPLETED:
12:30 PM
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On 5/30/24 at 10:30 a.m., Licensing Program Analysts (LPAs) Greg Clark and A. Gharachorloo arrived unannounced to conduct 1-Year Annual Required inspection. LPA met with Nemia Atendido, Licensee and explained the purpose of the visit

LPAs toured the facility including but not limited to bedrooms, bathrooms, kitchen, common area and backyard. All outdoor and indoor passageways are kept free of obstruction. There are no bodies of water. A comfortable temperature for clients is maintained at 70-degree Fahrenheit. LPA observed lighting in all rooms are adequate for the comfort and safety of the clients. Hot water temperature in the kitchen sink was measured at 106-degree Fahrenheit. All toilets, hand washing, and bathing are safe, sanitary and in operating condition. The supply of extra hygiene was available for clients. There is a minimum of one-week supply of non-perishables and 2-day perishables food supply.

Smoke detectors and carbon monoxide were in operating condition during visit. Fire extinguisher was last serviced on 4/10/24. First aid kit was observed to be complete. Fire drill was last conducted on 5/24/24.

LPAs reviewed 4 clients’ records and 4 staff records, and all were complete. A sample of 4 client’s medications were reviewed.

Updated copies of the following documents were requested for facility file and are to be submitted to CCL by 6/06/24: LIC 610D Emergency Disaster Plan

No deficiencies were cited during this inspection. Exit interview conducted and a copy of this report provided.
SUPERVISOR'S NAME: Yvonne Flores-LariosTELEPHONE: (510) 286-0517
LICENSING EVALUATOR NAME: Gregory ClarkTELEPHONE: 510-285-3927
LICENSING EVALUATOR SIGNATURE:
DATE: 05/30/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/30/2024
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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