<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 019200468
Report Date: 01/04/2022
Date Signed: 01/04/2022 12:34:33 PM

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:EASY LIVING CARE HOME-MEADOWLARKFACILITY NUMBER:
019200468
ADMINISTRATOR:CAROLINE YANKILINGFACILITY TYPE:
740
ADDRESS:538 MEADOWLARK STREETTELEPHONE:
(925) 989-3345
CITY:LIVERMORESTATE: CAZIP CODE:
94550
CAPACITY:6CENSUS: 4DATE:
01/04/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
11:30 AM
MET WITH:Grace Del Rosario, AdministratorTIME COMPLETED:
12:45 PM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
On 1/4/2022 at 12:00PM, Licensing Program Analysts (LPAs) G. Luk and G. Clark arrived unannounced to conduct a case management inspection due to a change of ownership. LPAs met with Administrator, Grace Del Rosario.

During Pre-licensing Inspection, LPAs observed the following deficiencies:

At 10:00AM, LPAs observed unlocked medications on top of the microwave, in the refrigerator, and in the cabinet. Staff locked medications during inspection.

At 10:15AM, LPAs measured hot water at 128.2 degrees F. Staff lowered hot water temperature during inspection. LPAs re-measured hot water at 110 degrees F during inspection.

The deficiencies were observed (see LIC 809D) and cited from the California Code of Regulation, Title 22. Failure to correct the deficiencies may result in civil penalties.

Exit interview conducted. A copy of this report and appeal rights provided.
SUPERVISOR'S NAME: Harpreet HumpalTELEPHONE: (510) 285-3928
LICENSING EVALUATOR NAME: Grace LukTELEPHONE: (510) 286-4201
LICENSING EVALUATOR SIGNATURE:

DATE: 01/04/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/04/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC809 (FAS) - (06/04)
Page: 1 of 2
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1515 CLAY STREET, STE. 310
OAKLAND, CA 94612

FACILITY NAME: EASY LIVING CARE HOME-MEADOWLARK
FACILITY NUMBER: 019200468
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/04/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
01/05/2022
Section Cited

1
2
3
4
5
6
7
Incidental Medical and Dental Care. Centrally stored medicines shall be kept in a safe and locked place that is not accessible to persons other than employees... This requirement is not met as evidence by:
8
9
10
11
12
13
14
Based on observation, licensee did not comply with the section cited above by having unlocked medications which poses an immediate health and safety risk to the persons in care.
8
9
10
11
12
13
14
Type A
01/05/2022
Section Cited

1
2
3
4
5
6
7
Maintenance and Operation. Hot water temperature controls shall be maintained...not less than 105 degree F and not more than 120 degree F... This requirement is not met as evidence by:
8
9
10
11
12
13
14
Based on observation, licensee did not comply with the section cited above by having hot water at 128.2 degrees F which poses an immediate health and safety risk to the persons in care.
8
9
10
11
12
13
14
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME: Harpreet HumpalTELEPHONE: (510) 285-3928
LICENSING EVALUATOR NAME: Grace LukTELEPHONE: (510) 286-4201
LICENSING EVALUATOR SIGNATURE:
DATE: 01/04/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/04/2022
LIC809 (FAS) - (06/04)
Page: 2 of 2