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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 019201041
Report Date: 02/10/2021
Date Signed: 02/10/2021 01:35:50 PM

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:CARING HANDSFACILITY NUMBER:
019201041
ADMINISTRATOR:MORALES, MERCEDESFACILITY TYPE:
740
ADDRESS:3536 MURPHY STREETTELEPHONE:
(925) 330-5129
CITY:LIVERMORESTATE: CAZIP CODE:
94550
CAPACITY:6CENSUS: 5DATE:
02/10/2021
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Mercedes Morales, AdministratorTIME COMPLETED:
01:20 PM
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On 2/10/2021 at 10:00AM, Licensing Program Analyst (LPA) G. Luk conducted a Tele-visit Pre-Licensing inspection via FaceTime due to shelter in place directed by the Governor. LPA spoke with Administrator, Mercedes Morales. The facility's fire clearance was approved for 6 non-ambulatory residents.

During the Tele-Inspection, LPA toured facility with Administrator including but not limited to resident's bedrooms, bathrooms, living room, dining room, kitchen, and outdoor area. Resident's bedrooms are fully furnished with bed, dresser, night stand, and chair. Resident's bathrooms were equipped with grab bars and showers have non-skid mats. LPA observed lighting in all rooms. LPA observed facility had a 7-day of non-perishable and 2-day perishable food supplies. Medication were locked in a kitchen cabinet during inspection. Smoke detectors are interconnected. Carbon Monoxide detectors were observed in common areas. First aid kit is complete. LPA advised Administrator that hot water temperature should be maintained between 105 degrees F and 120 degrees F. Indoor and outdoor passageways were free of obstruction. Fire extinguisher was observed to be full and last serviced on 3/9/2020. Emergency disaster plan was completed on 10/2/2020.

At 10:12AM, LPA observed lighter unlocked in a kitchen drawer. Administrator locked the lighter during inspection.

At 10:18AM, LPA observed R1 has a full bed rail and not on hospice care. Facility removed the full bed rail and replaced it with a half bed rail. Administrator will obtain a physician's order for the half bed rail and submit to CCLD by 2/17/2021.

LPA conducted Component III with Administrator during Tele-visit. LPA presented Component III Power Point and discussed the regulations embodied in the presentation.

Exit interview conducted and a copy of this report will be emailed.
SUPERVISOR'S NAME: Harpreet HumpalTELEPHONE: (510) 285-3928
LICENSING EVALUATOR NAME: Grace LukTELEPHONE: (510) 286-4201
LICENSING EVALUATOR SIGNATURE:

DATE: 02/10/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/10/2021
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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