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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 019200685
Report Date: 08/25/2022
Date Signed: 08/25/2022 01:26:35 PM


Document Has Been Signed on 08/25/2022 01:26 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:CAREFIELD CASTRO VALLEYFACILITY NUMBER:
019200685
ADMINISTRATOR:PARVEEN SINGHFACILITY TYPE:
740
ADDRESS:19960 SANTA MARIA AVETELEPHONE:
(510) 582-2765
CITY:CASTRO VALLEYSTATE: CAZIP CODE:
94546
CAPACITY:116CENSUS: DATE:
08/25/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
12:45 PM
MET WITH:Parveen Singh, Senior Executive DirectorTIME COMPLETED:
01:35 PM
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On 8/25/2022 starting at 12:42 PM, Licensing Program Analysts (LPAs) K. Nguyen and L. Francisco conducted a Health & Safety inspection as a result of a priority 2 complaint. LPAs met with Parveen Singh, Executive Director.

LPAs toured memory care facility with Resident Care Director including but not limited to the bathrooms, common areas, kitchen, and outdoor area. Hot water temperature was measured at 114 degrees F in the resident’s bathroom. 7-day of non-perishable and 2-day of perishable food supplies were sufficient. Refrigerator temperature was observed at 35 degrees F. Resident's medications were kept locked in the med room. Smoke detectors are interconnected with the sprinkler system. Carbon monoxide detector was observed. Fire extinguisher was observed to be fully charge. There are no accessible bodies of water observed. Indoor and outdoor passageways are free of obstruction. Facility appear to be safe and there are no imminent health/safety concerns on today's date.

No deficiencies cited during visit. Exit interview conducted and a copy of this report provided to Senior Executive Director.
SUPERVISOR'S NAME: Bennett FongTELEPHONE: (510) 725-7919
LICENSING EVALUATOR NAME: Kelly NguyenTELEPHONE: (510) 915-8702
LICENSING EVALUATOR SIGNATURE:
DATE: 08/25/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/25/2022
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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