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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 019200654
Report Date: 07/22/2024
Date Signed: 07/30/2024 11:02:34 AM

Document Has Been Signed on 07/30/2024 11:02 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
CCLD Regional Office, 1515 CLAY STREET, STE. 310
OAKLAND, CA 94612
FACILITY NAME:CENTRAL HOMEFACILITY NUMBER:
019200654
ADMINISTRATOR/
DIRECTOR:
RUDY GOLILAO,JRFACILITY TYPE:
735
ADDRESS:862 CENTRAL BLVD.TELEPHONE:
(510) 397-0122
CITY:HAYWARDSTATE: CAZIP CODE:
94542
CAPACITY: 4CENSUS: 4DATE:
07/22/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:25 AM
MET WITH:Rudy Goliao, AdministratorTIME VISIT/
INSPECTION COMPLETED:
11:30 AM
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LPA K. Nguyen arrived at the facility around 1:50PM. LPA rang the facility door bell no one comes answer. LPA observed all the blind are close, and no vehicle observed to be at the facility. LPA called the facility phone number that are listed 510-397-0122, but was not able to leave any messages because after three rang it went to a beeping sound. LPA will attempt to contact the facility at another time to conduct a 1-year requirement.

On 7/30/23 at 9:25 AM, Licensing Program Analyst (LPA) K. Nguyen arrived unannounced to conduct 1-Year Annual Required inspection. LPA met with Administrator, Rudy Golilao and explained the purpose of the visit. The facility’s fire clearance was approved for 4 ambulatory clients.

LPA toured the facility including but not limited to bedrooms, bathrooms, kitchen, common area and backyard. The facility consists of 3 total bedrooms which 3 bedrooms are occupied by the clients (one shared and two private) no room is designated for staff. All outdoor and indoor passageways are kept free of obstruction. There are no bodies of water. A comfortable temperature for clients is maintained at 77-degree Fahrenheit. LPA observed lighting in all rooms are adequate for the comfort and safety of the clients. Hot water temperature in the kitchen was measured at 109.4-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 4/29/24. Fire Drill was last posted on 6/29/24. First aid kit was observed to be complete.

At 10 am, 4 of 4 clients records were reviewed. At 10:45 am, 3 staff records were reviewed and 3 of 3 have current first aid training and associated to the facility. A sample of 3 client’s medications were reviewed.

No deficiencies were cited during this inspection. Exit interview conducted and a copy of this report provided.
SUPERVISORS NAME: Bennett Fong
LICENSING EVALUATOR NAME: Kelly Nguyen
LICENSING EVALUATOR SIGNATURE: DATE: 07/22/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/22/2024
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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