<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 019200936
Report Date: 04/21/2022
Date Signed: 04/21/2022 01:58:49 PM

Document Has Been Signed on 04/21/2022 01:58 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:NEW HOPEFACILITY NUMBER:
019200936
ADMINISTRATOR:VILLANUEVA, RICHMONDFACILITY TYPE:
735
ADDRESS:7794 CARDIGAN STREETTELEPHONE:
(925) 999-9109
CITY:DUBLINSTATE: CAZIP CODE:
94568
CAPACITY: 6CENSUS: 6DATE:
04/21/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
12:05 PM
MET WITH:Richmond Villanueva, AdministratorTIME COMPLETED:
02:05 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 4/21/22 at 12:05pm, Licensing Program Analysts (LPAs), K. Nguyen and L. Francisco arrived unannounced to conduct Infection Control Inspection. LPAs met with Administrator, Richmond Villanueva, and explained the purpose of the visit.

During the Infection Control Inspection, LPAs toured facility with Lead Staff, Joel Moya including but not limited to front entrance, screening station, hand washing stations, bedrooms, common areas, kitchen and backyard. Facility has a sufficient 2-day perishable and one week non-perishable food supply. There is one central entry point for universal screening for staff, residents and visitors. A sign-in policy, thermometer and hand sanitizer were observed at screening station. Cough/sneeze etiquette, social distancing and hand washing posters were observed. Facility staff were observed to be wearing proper PPE. LPAs observed sufficient PPE supply. Facility has a mitigation plan and maintains record of routine screening for residents and staff.

Updates copies of the following documents were requested for facility files and are to be submitted to CCL by 4/25/22:

-LIC 610D Emergency Disaster Plan

No deficiencies cited during visit. Exit interview conducted and due to technical difficulties, report is being provided via email.
SUPERVISORS NAME: Bennett Fong
LICENSING EVALUATOR NAME: Kelly Nguyen
LICENSING EVALUATOR SIGNATURE: DATE: 04/21/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/21/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 4