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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 019200779
Report Date: 06/21/2024
Date Signed: 06/21/2024 04:55:55 PM

Document Has Been Signed on 06/21/2024 04:55 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:ANDALUCIA HOMEFACILITY NUMBER:
019200779
ADMINISTRATOR/
DIRECTOR:		LEGARDA, MARISSAFACILITY TYPE:
735
ADDRESS:1083 ANDALUCIA STREETTELEPHONE:
(650) 892-9264
CITY:LIVERMORESTATE: CAZIP CODE:
94550
CAPACITY: 4CENSUS: 3DATE:
06/21/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
12:30 PM
MET WITH:Marlo Legarda, Staff
Irwyn Legarda, Staff		TIME VISIT/
INSPECTION COMPLETED:
04:00 PM
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On 6/21/2024 at 12:30PM, Licensing Program Analyst (LPA) G. Luk arrived unannounced to conduct a Required - 1 Year inspection. LPA met with staff, Marlo Legarda and Irwyn Legarda. The facility’s fire clearance was approved for 4 ambulatory clients.

LPA toured the facility including but not limited to bedrooms, bathrooms, dining area, kitchen, garage, and outdoor area. Smoke and carbon monoxide detectors were observed. Fire extinguishers were observed to be full and last serviced on 4/29/2024. One week of nonperishable and 2-day of perishable food supplies were available. Hot water temperature was measured at 109.6 degrees F in the hallway bathroom. LPA observed grab bars and non-skid mat in the bathroom. There were adequate lights in each room. First Aid kit is complete. No bodies of water observed. Indoor and outdoor passageways were free of obstruction. Last disaster drill was conducted on 5/26/2024.

LPA reviewed 3 clients and 3 staff files starting at 1:30PM. LPA reviewed client's P & I money with log. LPA reviewed client's medications starting at 2:30PM. LPA interviewed 2 clients and 2 staff during inspection.

No deficiencies are being cited on this date.

Exit interviewed conducted with Irwyn Legarda. A copy of this report provided.
SUPERVISORS NAME: Harpreet Humpal
LICENSING EVALUATOR NAME: Grace Luk
LICENSING EVALUATOR SIGNATURE: DATE: 06/21/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/21/2024
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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