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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 019200655
Report Date: 11/07/2024
Date Signed: 11/07/2024 04:49:45 PM

Document Has Been Signed on 11/07/2024 04:49 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:ALOHA RESIDENTIAL CARE INCFACILITY NUMBER:
019200655
ADMINISTRATOR/
DIRECTOR:
KATELYN SALVADORFACILITY TYPE:
735
ADDRESS:34706 WILLIAMS WAYTELEPHONE:
(510) 972-0900
CITY:UNION CITYSTATE: CAZIP CODE:
94587
CAPACITY: 6CENSUS: 6DATE:
11/07/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
11:45 AM
MET WITH:Katelyn Salvador Adminstrator TIME VISIT/
INSPECTION COMPLETED:
05:15 PM
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On 11/07/2024 around 11:45 AM, Licensing Program Analyst (LPA) L. Holmes arrived unannounced to conduct a 10-day complaint investigation for the above allegations. LPA met with Care Staff Gina White, and Nicholas Marcelo. LPA delivered the findings of the complaint to Katelyn Salvador Administrator (ADM) and explained the purpose for the visit.

Upon arrival, LPA observed one (1) Care Staff attending to the facility, and one (1) resident was sleeping. LPA toured the facility with the two Care Staff. The areas included but were not limited to the common areas, bedrooms, dining room, bathrooms, kitchen, garage, and backyard. The facility consists of two levels and the residents are on both floors. All outdoor and indoor passageways were free of obstruction. There were no bodies of water present. A comfortable temperature was maintained at 72 degrees Fahrenheit (F). LPA observed lighting in all areas to be adequate for the comfort and safety of the residents. The hot water temperature in the shared restroom on the 1st floor was measured at 109.8 degrees (F). The shared restroom had paper towels, soap and garbage cans; all areas were safe and sanitary. PPE, sanitizer, and paper goods remain sufficient. There is a 2-day supply of perishable foods and a 7-day supply of non-perishable foods.
Smoke detectors and carbon monoxide were in operating condition during visit. Fire extinguisher was observed full and serviced 10/17/24. Emergency Disaster Plan is updated. Safety drills are rotational between months and last conducted 10/23/24. LPA reviewed four (4) client files, and three (3) staff files.

Exit interview conducted and a copy of this report provided to Katelyn Salvador, Administrator.

SUPERVISORS NAME: Yvonne Flores-Larios
LICENSING EVALUATOR NAME: Lisha Holmes
LICENSING EVALUATOR SIGNATURE: DATE: 11/07/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/07/2024
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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