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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 019200484
Report Date: 09/30/2024
Date Signed: 09/30/2024 04:13:42 PM

Document Has Been Signed on 09/30/2024 04:13 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:SUNOL CREEK MEMORY CAREFACILITY NUMBER:
019200484
ADMINISTRATOR/
DIRECTOR:		RAMIREZ, MARGARET DIVINEFACILITY TYPE:
740
ADDRESS:5980 SUNOL BLVDTELEPHONE:
(925) 846-8283
CITY:PLEASANTONSTATE: CAZIP CODE:
94566
CAPACITY: 46CENSUS: 37DATE:
09/30/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
02:30 PM
MET WITH:Harmony Venturelli, Executive DirectorTIME VISIT/
INSPECTION COMPLETED:
04:30 PM
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On 9/30/2024 at 2:30PM, Licensing Program Analyst (LPA) G. Luk arrived unannounced to conduct Case Management Inspection in regards to the incident report that was received on 9/26/2024. LPA met with Executive Director, Harmony Venturelli and explained the reason for the visit.

Incident report dated 9/26/2024 states that R1 returned from the dermatologist for follow up on a rash and was diagnosed with scabies.

During visit, LPA interviewed staff and reviewed R1's files. R1's care notes revealed that R1 was seen by the doctors when R1 first had signs of itchiness or a rash in the beginning of August 2024. R1's rash was treated by the doctors and facility staff followed up with R1's doctor as needed until the doctor recommended R1 to see a dermatologist.


No deficiencies are being cited on this date.


Exit interview conducted. A copy of this report provided
SUPERVISORS NAME: Harpreet Humpal
LICENSING EVALUATOR NAME: Grace Luk
LICENSING EVALUATOR SIGNATURE: DATE: 09/30/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/30/2024
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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