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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 019201160
Report Date: 05/25/2022
Date Signed: 05/25/2022 02:53:59 PM

Document Has Been Signed on 05/25/2022 02:53 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:REAMER RESIDENCEFACILITY NUMBER:
019201160
ADMINISTRATOR:LAKANDULA, IRENALDFACILITY TYPE:
735
ADDRESS:18039 REAMER ROADTELEPHONE:
(510) 674-9229
CITY:CASTRO VALLEYSTATE: CAZIP CODE:
94546
CAPACITY: 4CENSUS: 4DATE:
05/25/2022
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
01:25 PM
MET WITH:Irenal Lakandula, AdministratorTIME COMPLETED:
03:05 PM
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On 5/25/2022 at 1:25 PM, Licensing Program Analysts (LPAs) K. Nguyen, and L. Francisco arrived unannounced to conduct Pre-licensing Inspection. Upon arrival, LPAs met with Irenal Lakandula Administrator and explained the purpose of the visit. The facility's was approve for 4 clients fire clearance was approved for two ambulatory and 2 non-ambulatory clients. The facility currently is licensed as a group home with 4 existing clients. However, facility is in the process of changing facility type and inspection is being conducted as a new Adult Residential Care Facility (ARF) facility.

LPAs toured facility with Administrator including but not limited to 5 bedrooms, 1 staff room, 3 bathrooms, kitchen, common areas and backyard. Bedrooms and living rooms were equipped with the proper furniture. Bathrooms were equipped with non-skid mats. Linens and hygiene supplies were observed inside a cabinet. There is sufficient lighting throughout facility. Room temperature was maintained at 77 degrees F and hot water temperature was maintained at 107 degrees F. First-aid kit was observed to be complete. Smoke detectors and carbon monoxide were observed. Fire extinguisher was last serviced on March 7, 2022.

LPAs observed that facility is ready to be licensed. This report will be submitted to the Central Applications Unit (CAU) and a final review of the application will be conducted. This facility is not yet licensed, and is subject to final approval by CAU. Additional requirements may still be required.

Exit interview conducted and a copy of this report provided.
SUPERVISORS NAME: Bennett Fong
LICENSING EVALUATOR NAME: Kelly Nguyen
LICENSING EVALUATOR SIGNATURE: DATE: 05/18/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/25/2022
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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