019200807-2-18-2025-15-AS-KNGN-DDZVSJ-20250218154137

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 019200807
Report Date: 02/18/2025
Date Signed: 02/18/2025 03:41:50 PM

Document Has Been Signed on 02/18/2025 03:41 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:	CONTINUANCE CARE HOME LLC		FACILITY NUMBER:	019200807
ADMINISTRATOR/ DIRECTOR:	MARSHALL, SHIRLEY		FACILITY TYPE:	740
ADDRESS:	565 SCHAFER RD		TELEPHONE:	(510) 398-8994
CITY:	HAYWARD	STATE: CA	ZIP CODE:	94544
CAPACITY: 16	TOTAL ENROLLED CHILDREN: 0	CENSUS: 15	DATE:	02/18/2025
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	10:00 AM
MET WITH:	Shirley Marshall, Administrator		TIME VISIT/ INSPECTION COMPLETED:	04:00 PM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	On 2/18/2025 at 10:00AM, Licensing Program Analyst (LPA) K. Nguyen conducted an unannounced 1-Year Required inspection. LPA met with Sarah Horny, Caregiver, and explained the purpose of the visit. LPA spoke to Administrator Shirley Marshall currently holds a certificate (#6005261740) that expired on 06/26/2025. The facility’s fire clearance was approved for sixteen (16) non-ambulatory residents. LPA toured the facility with Caregiver including but not limited to bedrooms, bathrooms, kitchen, common area, and side yard. The facility consists of five (8) room total and two (3) bathrooms. No bodies of water observed. A comfortable temperature is maintained at 68 Degree F.. LPA observed lighting in all rooms are adequate for the comfort and safety of the residents. The hot water temperature in the residents’ shared bathroom was measured at 109.9 degrees Fahrenheit. Residents’ bathrooms are equipped with grab bars and non-skid mats. Smoke detectors and carbon monoxide were in operating condition during visit. Fire extinguisher was last serviced on 02/29/2024. Emergency Disaster Plan was updated on 2/1/2025 and posted. First aid kit was observed to be complete. Facility liability insurance policy term effective date: 6/13/2024 to 6/13/2025. Fire drill was conducted on 2/3/25. Staff files was incomplete and two (2) of the (5) staff files are missing CPR and education/training which is considered incomplete. Report continue from LIC 809c

Bennett Fong	TELEPHONE: (510) 725-7919
Kelly Nguyen	TELEPHONE: (510) 915-8702
	DATE: 02/18/2025

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/18/2025

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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Document Has Been Signed on 02/18/2025 03:41 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1515 CLAY STREET, STE. 310
OAKLAND, CA 94612

FACILITY NAME: CONTINUANCE CARE HOME LLC	FACILITY NUMBER: 019200807
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 02/18/2025

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Section Cited

CCR

87309(a)

Storage Space and Access

(a) Except as specified in subsection (b), the licensee shall ensure that disinfectants, cleaning solutions, poisonous substances, knives, matches, tools, sharp objects, and other similar items which could pose a danger to residents are in locked storage and are not left unattended if outside the locked storage. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observation, the licensee did not comply with the section cited above in by having unlock chemicals such as disinfectant cleaner, a tub of fast setting cement patcher, and a battery left under the sun on the porch that label (danger/ poison), which poses an immediate health, safety or personal rights risk to persons in care.
	POC Due Date: 02/18/2025
	Plan of Correction
1 2 3 4	Administrator (staff) lock up chemical during inspection. Deficiency cleared during inspection.

Section Cited


	Deficient Practice Statement
1 2 3 4
	POC Due Date:
	Plan of Correction
1 2 3 4

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

Bennett Fong	TELEPHONE: (510) 725-7919
Kelly Nguyen	TELEPHONE: (510) 915-8702
	DATE: 02/18/2025

I acknowledge receipt of this form and understand my appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/18/2025

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 02/18/2025 03:41 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1515 CLAY STREET, STE. 310
OAKLAND, CA 94612

FACILITY NAME: CONTINUANCE CARE HOME LLC	FACILITY NUMBER: 019200807
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 02/18/2025

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Section Cited

CCR

87303(a)

Maintenance and Operation

(a) The facility shall be clean, safe, sanitary and in good repair at all times. Maintenance shall include provision of maintenance services and procedures for the safety and well-being of residents, employees and visitors. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observation, front door frame are broken, and the third window screen is broken. Between the emergency door there is a hole on the left side bottom wall. the licensee did not comply with the section cited above in [count] out of [total count] [(objects) (persons)] [identifiers] which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 03/04/2025
	Plan of Correction
1 2 3 4	Administrators agree to fix broken door frame, window screen, and patch the hold on the wall. Administrators agree to send in picture via email to CCLD by POC date 3/4/2025

Type B

Section Cited

CCR

87412(a)

Personnel Records

(a) The licensee shall ensure that personnel records are maintained on the licensee, administrator and each employee. Each personnel record shall contain the following information: This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on interview, record review, the licensee did not comply with the section cited above by not having a complete staff files which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 02/25/2025
	Plan of Correction
1 2 3 4	Administrators agree to have all staff files complete and submit documentation via email to CCLD by POC date 2/25/2025.

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

Bennett Fong	TELEPHONE: (510) 725-7919
Kelly Nguyen	TELEPHONE: (510) 915-8702
	DATE: 02/18/2025

I acknowledge receipt of this form and understand my appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/18/2025

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 02/18/2025 03:41 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1515 CLAY STREET, STE. 310
OAKLAND, CA 94612

FACILITY NAME: CONTINUANCE CARE HOME LLC	FACILITY NUMBER: 019200807
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 02/18/2025

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Section Cited

HSC

1569.69(a)

Other Provisions

(a) Each residential care facility for the elderly licensed under this chapter shall ensure that each employee of the facility who assists residents with the self-administration of medications meets all of the following training requirements: This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on interview, and record review, the licensee did not comply with the section cited above by not having staff training on records which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 02/25/2025
	Plan of Correction
1 2 3 4	Administrators agree to have all staff training on files submit documentation via email to CCLD by POC date 2/25/2025.

Section Cited


	Deficient Practice Statement
1 2 3 4
	POC Due Date:
	Plan of Correction
1 2 3 4

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

Bennett Fong	TELEPHONE: (510) 725-7919
Kelly Nguyen	TELEPHONE: (510) 915-8702
	DATE: 02/18/2025

I acknowledge receipt of this form and understand my appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/18/2025

LIC809 (FAS) - (06/04)

Page: 4 of 5

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1515 CLAY STREET, STE. 310
OAKLAND, CA 94612

FACILITY NAME: CONTINUANCE CARE HOME LLC	FACILITY NUMBER: 019200807
	VISIT DATE: 02/18/2025

NARRATIVE

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LPA observed the following deficiencies:

· At 11:59am, LPA observed unlocked chemicals such as disinfectant cleaner, fast setting cement patcher, and a battery left under the sun on the porch that label (danger/ poison). Deficiency clear during visit.

· At 12:15pm, LPA observed front door frame are broken, and the third window screen is broken. Between the emergency door there is a hole on the left side bottom wall.

· At 1:50pm, LPA observed staff files incomplete including training records..

The deficiencies were observed (see LIC809D) and cited from the California Code of Regulation, Failure to submit proof of corrections (POC) by plan of correction due date and/or any repeat deficiencies within a 12-month period may result in civil penalties.

Exit interview conducted. A copy this report and appeal rights provided.

SUPERVISOR'S NAME: Bennett Fong	TELEPHONE: (510) 725-7919
LICENSING EVALUATOR NAME: Kelly Nguyen	TELEPHONE: (510) 915-8702
LICENSING EVALUATOR SIGNATURE:	DATE: 02/18/2025

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/18/2025

LIC809 (FAS) - (06/04)

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