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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 019200444
Report Date: 02/23/2023
Date Signed: 02/23/2023 10:39:15 AM

Document Has Been Signed on 02/23/2023 10:39 AM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
E BAY DELTA AC/SC, 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: 20DATE:
02/23/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:05 AM
MET WITH:Nancy Santiago, Instructor
Brian Jimenez, Lead Staff		TIME COMPLETED:
10:50 AM
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On 2/23/2023 at 9:05 AM, Licensing Program Analyst (LPA) P. Watson arrived unannounced to conduct an annual Infection Control Inspection. LPA met Lead Staff, Brian Jimenez and explained the purpose of the visit. Brian stated that their Program Coordinator Marisol Salcedo is currently on vacation and is unable to join the visit. LPA was unable to speak to the Program Coordinator.

During the Infection Control Inspection, LPA toured facility with Brian including but not limited to front entrance, screening station, hand washing stations, bathrooms, activity rooms, and kitchen area. There is one central entry point for universal screening for staff, residents, and visitors. A sign-in policy, thermometer and hand sanitizer were observed at screening station. Cough/sneeze etiquette, social distancing and hand washing posters were observed. Common touched surfaces are disinfected at least once daily.
Bathrooms are equipped with liquid soap, paper towel and trash bins. Facility staff were observed to be wearing proper PPE. Facility has a 30 day supply of PPEs maintained at central location and easily accessible for staff. Facility has a mitigation plan and maintains record of routine screening for residents and staff. Smoke and carbon monoxide detectors were observed and are connected to the sprinkler system. First Aid kit was complete. Fire extinguishers were observed. LPA observed facility passages inside and out free of obstruction.


No deficiencies cited during visit. Exit interview conducted and a copy of this report provided.
SUPERVISORS NAME: Yvonne Flores-Larios
LICENSING EVALUATOR NAME: Paris Watson
LICENSING EVALUATOR SIGNATURE: DATE: 02/23/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/23/2023
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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