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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 019201093
Report Date: 10/21/2024
Date Signed: 10/21/2024 03:06:25 PM

Document Has Been Signed on 10/21/2024 03:06 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:LILY HOUSEFACILITY NUMBER:
019201093
ADMINISTRATOR/
DIRECTOR:		CURRY, CASSANDRA B.FACILITY TYPE:
735
ADDRESS:4355 COLGATE WAYTELEPHONE:
(925) 493-7968
CITY:LIVERMORESTATE: CAZIP CODE:
94550
CAPACITY: 6CENSUS: 6DATE:
10/21/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:15 AM
MET WITH:Cassandra Curry, Administrator
Corina Grajeda, Caregiver		TIME VISIT/
INSPECTION COMPLETED:
02:00 PM
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On 10/21/2024 at 9:15AM, Licensing Program Analyst (LPA) G. Luk arrived unannounced to conduct a Required - 1 Year inspection. LPA met with caregiver, Corina Grajeda and informed her the reason for the visit. Administrator, Cassandra Curry arrived 30 minutes later.

LPA toured the facility including but not limited to bedrooms, bathrooms, dining area, kitchen, garage, and outdoor area. Smoke and carbon monoxide combination detectors were observed. Fire extinguishers were observed to be full and last serviced on 5/21/2024. One week of nonperishable and 2-day of perishable food supplies were available. Hot water temperature was measured at 115.2 degrees F in the hallway bathroom. LPA observed grab bars and non-skid mat in the bathrooms. First Aid kit is complete. No bodies of water observed.

LPA reviewed 6 clients and 5 staff files starting at 10:00AM. LPA reviewed client's P&I money with log and there was no discrepancies observed. LPA reviewed a sample of client's medications. LPA interviewed 2 staff during inspection.

Facility was issued technical violations (TVs) and reports will be provided.

No deficiencies are being cited on this date.

Exit interview conducted. A copy of this report provided.
SUPERVISORS NAME: Harpreet Humpal
LICENSING EVALUATOR NAME: Grace Luk
LICENSING EVALUATOR SIGNATURE: DATE: 10/21/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/21/2024
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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