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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 019200936
Report Date: 12/09/2021
Date Signed: 12/17/2021 08:35:00 AM

Document Has Been Signed on 12/17/2021 08:35 AM - 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,
, CA
FACILITY NAME:NEW HOPEFACILITY NUMBER:
019200936
ADMINISTRATOR:VILLANUEVA, RICHMONDFACILITY TYPE:
735
ADDRESS:7794 CARDIGAN STREETTELEPHONE:
(925) 999-9109
CITY:DUBLINSTATE: CAZIP CODE:
94568
CAPACITY: 6CENSUS: 6DATE:
12/09/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
12:30 PM
MET WITH:Richmond Villanueva, AdministratorTIME COMPLETED:
02:15 PM
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Licensing Program Analyst (LPA) Tobola arrived unannounced to conduct a Required - 1 Year inspection and was greeted by Lead Staff Joel Moya, with Administrator, Richard Villanueva (RV) arriving later in the visit. The annual inspection is focused on the Infection Control procedures and practices of this Adult Residential Facility. There are 6 clients in care, 1 of which was at Day Program at the time of visit.

LPA toured facility and grounds with Lead Staff and observed COVID-19 precaution signs posted in common areas to promote hand washing and physical distancing. LPA was screened for COVID-19 symptoms upon entrance to this facility. Visitors are said to be screened for COVID-19 symptoms (including temperature check) upon arrival to the facility. Infection control practices are present: entry procedures, face coverings, daily monitoring and temperatures checked for residents and staff, and 30-day PPE supply. Staff follow indoor visitation requirement of verifying and tracking COVID-19 vaccination or verify non-essential visitors have proof of a negative COVID-19 test within 72 hours. Staff clean and disinfect the facility per shift change or as needed. Administrator stated high touched surface areas are disinfected after each use, such as the bathroom and kitchen area. Client rooms and common areas have disinfecting wipes and hand sanitizer. Bathrooms are equipped with liquid soap, paper towels and garbage cans with touch less lids. Facility submitted a mitigation program plan, and plan has been reviewed. Caregivers have completed PPE training however, Administrator to schedule N-95 Mask Fit Testing Trainin all staff.

In addition, facility was found to be at a comfortable temperature with all exits free from obstruction. No accessible bodies of water or fire safety hazards observed. Fire Extinguishers were found to be charged and serviced 6/14/2021. Smoke and Carbon monoxide detectors were tested and fully operational.
There was sufficient supply of both perishable and nonperishable foods as required by Title 22 Regulations. Food stored in the kitchen refrigerator were properly stored as per regulations on this day at the time of the visit.
Continued onto LIC809-C
SUPERVISORS NAME: Kimberley Mota
LICENSING EVALUATOR NAME: Dominic Tobola
LICENSING EVALUATOR SIGNATURE: DATE: 12/09/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/09/2021
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office,
, CA
FACILITY NAME: NEW HOPE
FACILITY NUMBER: 019200936
VISIT DATE: 12/09/2021
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LPA requested the following updated documents to be submitted to CCLD by 12/16/2021:
  • LIC500 Personnel Report
  • LIC308 Designation of Administrative Responsibility
  • LIC610 Emergency Disaster Plan

Exit interview conducted with Administrator, whose signature on this document confirms receipt.
Due to printer malfunction, this report was emailed to Administrator.

No deficiencies cited during this inspection
SUPERVISORS NAME: Kimberley Mota
LICENSING EVALUATOR NAME: Dominic Tobola
LICENSING EVALUATOR SIGNATURE:

DATE: 12/09/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/09/2021
LIC809 (FAS) - (06/04)
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