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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 019200444
Report Date: 04/28/2022
Date Signed: 04/28/2022 12:25:30 PM

Document Has Been Signed on 04/28/2022 12:25 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:WAY OF THE ELDERSFACILITY NUMBER:
019200444
ADMINISTRATOR:SISTER MARYGRACE PUCHACFACILITY TYPE:
775
ADDRESS:2700-A MERCED STREETTELEPHONE:
(510) 352-1867
CITY:SAN LEANDROSTATE: CAZIP CODE:
94577
CAPACITY: 40CENSUS: 23DATE:
04/28/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
11:40 AM
MET WITH:Marisol Salcedo, Program CoodinatorTIME COMPLETED:
12:30 PM
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On 04/28/22 at 11:45 a.m., Licensing Program Analysts (LPA) G. Clark And L. Fici arrived unannounced to conduct Infection Control Inspection. LPAs met with Program Coordinator Marisol Saledo and explained the purpose of the visit.

During the Infection Control Inspection, LPAs toured facility including but not limited to: front entrance, screening station, hand washing stations, common areas, bathrooms, kitchen and backyard. There is one central entry point for universal screening for staff, clients and visitors. A sign-in policy, thermometer and hand sanitizer were observed at screening station. Cough/sneeze etiquette, social distancing and hand washing posters will be reinstalled. Facility staff were observed to be wearing proper PPE. Facility has a 30-day supply of PPE maintained at central location and easily accessible for staff. Facility has a mitigation plan and maintains record of routine screening for clients and staff.

No deficiencies cited during visit. Exit interview conducted and a copy of this report provided.
SUPERVISORS NAME: Yvonne Flores-Larios
LICENSING EVALUATOR NAME: Gregory Clark
LICENSING EVALUATOR SIGNATURE: DATE: 04/28/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/28/2022
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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