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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 019201107
Report Date: 12/22/2021
Date Signed: 12/22/2021 10:38:43 AM

Document Has Been Signed on 12/22/2021 10:38 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, 1515 CLAY STREET, STE. 310
OAKLAND, CA 94612
FACILITY NAME:LIBBIE CARE HOME 2FACILITY NUMBER:
019201107
ADMINISTRATOR:CHAND, VIMALFACILITY TYPE:
735
ADDRESS:2236 WESTMINISTERTELEPHONE:
(707) 819-6323
CITY:LIVERMORESTATE: CAZIP CODE:
94551
CAPACITY: 5CENSUS: 0DATE:
12/22/2021
TYPE OF VISIT:Case Management - OtherANNOUNCEDTIME BEGAN:
08:45 AM
MET WITH:Vimal Chand, LicenseeTIME COMPLETED:
10:50 AM
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On 12/22/2021 at 8:45AM, Licensing Program Analyst (LPA) G. Luk arrived to conduct case management inspection to follow up with the corrections needed during the Pre-Licensing Inspection on 12/3/2021. LPA met with Licensee, Vimal Chand.

During visit, LPA toured the facility including bedrooms, bathrooms, common areas, garage, and outdoor areas. Licensee informed LPA that the water heater was replaced. LPA measured hot water temperature at 120 degrees F in the hallway bathroom. LPA observed 5 ft fence with lock gate in front of the pool and clients would not have access to the pool. The left side gate is now a closed fence as shown on the facility sketch and clients would not have access to the pool from the left side fence. Bedroom 3 closet have a board covering the crawl space access. LPA observed a switch cover in the staff room by the front door. LPA observed a lock was installed in the medication cabinet next to the refrigerator. LPA observed fixture above the kitchen sink was installed. Smoke detector was installed in the living and no exposed wires observed. LPA observed postings including CCLD poster, personal rights, visiting policy, and admission agreement. Licensee completed LIC610E and have a copy of the sample menu.

The following will need to be completed before recommending licensure to Centralized Application Bureau (CAB):

1. LPA was informed that a phone line have not been installed. Licensee had scheduled with Comcast on 12/29/2021 to install the phone line.

Licensee/applicant will submit proof of corrections to CCL on/before 12/30/2021.



Exit interview conducted and a copy of this report provided.
SUPERVISORS NAME: Harpreet Humpal
LICENSING EVALUATOR NAME: Grace Luk
LICENSING EVALUATOR SIGNATURE: DATE: 12/22/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/22/2021
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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