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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 019200744
Report Date: 12/07/2021
Date Signed: 12/07/2021 11:52:33 AM

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:SACRED HANDS LIVINGFACILITY NUMBER:
019200744
ADMINISTRATOR:PANESAR, RAJWANTFACILITY TYPE:
740
ADDRESS:2980 BLUMEN AVETELEPHONE:
(925) 392-8652
CITY:BRENTWOODSTATE: CAZIP CODE:
94513
CAPACITY:6CENSUS: 5DATE:
12/07/2021
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
11:15 AM
MET WITH:Rajwant Panesar, AdministratorTIME COMPLETED:
12:10 PM
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On 12/7/2021 starting at 11:15 AM, Licensing Program Analyst (LPA) L. Francisco conducted a Case Management while at the facility for another matter. LPA met with Administrator, Rajwant Panesar.

During a complaint investigation (#15-AS-20200408083147) on 10/11/2021, LPA discovered facility's protocol is to contact resident's responsible party before calling 9-1-1 due to cost of co-pay. LPA went over Title 22 regulation, 87465(g) Incidental Medical and Dental Care with Administrator and requested Administrator to provide LPA a copy training with staff on when to call 9-11 and procedure no later 12/20/2021.

No deficiencies cited during visit. Due to technical difficulties, a copy of this report provided via email.
SUPERVISOR'S NAME: Harpreet HumpalTELEPHONE: (510) 285-3928
LICENSING EVALUATOR NAME: Lizette FranciscoTELEPHONE: (510) 286-4201
LICENSING EVALUATOR SIGNATURE:

DATE: 12/07/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/07/2021
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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