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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 019200807
Report Date: 04/12/2023
Date Signed: 04/12/2023 03:43:34 PM


Document Has Been Signed on 04/12/2023 03:43 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 LLCFACILITY NUMBER:
019200807
ADMINISTRATOR:MARSHALL, SHIRLEYFACILITY TYPE:
740
ADDRESS:565 SCHAFER RDTELEPHONE:
(510) 398-8994
CITY:HAYWARDSTATE: CAZIP CODE:
94544
CAPACITY:16CENSUS: 14DATE:
04/12/2023
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
02:25 PM
MET WITH:Shirley Marshall, AdministratorTIME COMPLETED:
04:00 PM
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At around 2:25 pm, Licensing Program Analyst (LPA) Luisa Fontanilla arrived unannounced to conduct a POC visit and met with Shirley Marshall. LPA explained to Administrator purpose of the visit.

LPA and Administrator reviewed updated medication list and medicine. LPA observed Vit D3 order is 25 mcg but the supply is 10 mcg. And a new prescription, Vit D2 was added to the list. Administrator states the new prescription is waiting for order from the doctor.

One of the staff went to the pharmacy to pick up correct dose of Vit D3.

Additional civil penalty of $600 from 4/6 - 4/11, 2023 (6) days is being assessed.

Administrator will notify LPA once Vit D2 is received.

The deficiency related to ongoing civil penalties is cleared.

A copy of this report was provided to Administrator.
SUPERVISOR'S NAME: Yvonne Flores-LariosTELEPHONE: (510) 286-0517
LICENSING EVALUATOR NAME: Luisa FontanillaTELEPHONE: (510) 286-7147
LICENSING EVALUATOR SIGNATURE:
DATE: 04/12/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/12/2023
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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