019201187-8-18-2022-15-AS-GLUK-CHESGA-20220818135138

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 019201187
Report Date: 08/18/2022
Date Signed: 08/18/2022 01:51:45 PM

Document Has Been Signed on 08/18/2022 01:51 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:	HOPE SENIOR ESTATES		FACILITY NUMBER:	019201187
ADMINISTRATOR:	FRENTI, TATIANA		FACILITY TYPE:	740
ADDRESS:	417 COLUSA WAY		TELEPHONE:	(925) 549-7843
CITY:	LIVERMORE	STATE: CA	ZIP CODE:	94551
CAPACITY:	6	CENSUS: 0	DATE:	08/18/2022
TYPE OF VISIT:	Prelicensing	UNANNOUNCED	TIME BEGAN:	09:15 AM
MET WITH:	Tatiana Frenti, Administrator/Licensee Ruben Frenti, Licensee		TIME COMPLETED:	12:30 PM

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On 8/18/2022 at 9:15AM, Licensing Program Analysts (LPAs) G. Luk and P. Watson conducted a Pre-licensing Inspection. LPAs met with Licensee(s), Tatiana Frenti and Ruben Frenti.

The facility's fire clearance was approved for 4 ambulatory and 2 non-ambulatory residents.

LPAs toured facility including but not limited to resident's bedrooms, bathroom, living room, kitchen, garage, and outdoor area. Hot water was measured at 115 degrees F in the kitchen sink. LPAs observed lighting in all rooms. LPAs observed facility had some non-perishable and perishable food supply. Licensee will purchase additional food supplies once facility is licensed. Carbon monoxide and smoke detectors were observed.

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

1. Fire extinguisher was observed to be full, but unknown when it was last purchased or serviced. Licensee agreed to either provide a copy of the purchase receipt or have it serviced.

2. Facility has exposed sewer in the front lawn by the front door. Bedroom one's screen door was ripped near the handle and on the bottom. Caulking along the sides of fireplace are cracked. There's a open hole behind the front closet where the vent for furnace is located.

3. There were no grab bars in the bathroom for shower and toilet areas. There were no curtains in the shower area.

(Continue on LIC809C...)

SUPERVISOR'S NAME: Harpreet Humpal	TELEPHONE: (510) 285-3928
LICENSING EVALUATOR NAME: Grace Luk	TELEPHONE: (510) 286-4201
LICENSING EVALUATOR SIGNATURE:	DATE: 08/18/2022

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/18/2022

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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1515 CLAY STREET, STE. 310
OAKLAND, CA 94612

FACILITY NAME: HOPE SENIOR ESTATES	FACILITY NUMBER: 019201187
	VISIT DATE: 08/18/2022

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4. Facility only had one flash light which was dim. Facility does not have a first aid kit.

5. Resident's bedrooms does not have furniture including bed, chair, dresser, night stand, and lamp. There were no bedding observed including mattress pads, fitted sheet, flat sheet, comforter, and pillows.

6. Back yard area had construction items out including bricks, buckets, paints, wood, boxes, and other items that needs to be disposed.

7. Fence around the swimming pool is not 5 feet in height and was not completed or locked during inspection.

8. Facility had no area to lock medications, knives, cleaning supplies, and other dangerous items.

9. Facility had no land line phone installed.

10. Facility does not have postings including CCLD Complaint poster (20''x26''), theft policy, personal rights, Ombudsman, admission agreement, rights to residential council, emergency contact phone numbers, sketch for emergency exits, and COVID-19.

11. Right side gate was locked.

12. Update LIC610D to include 72 hours self-reliant, update CCLD phone number, and 2 shelter locations.

13. Fire safety plan should be available at the facility.

14. Update facility and yard sketch to show RV, pool fence, dog house, and garage conversion. Licensee will create a plan to address the garage being converted into bedroom, bathroom, office, and closet areas for private use.

Licensee(s) will submit proof of corrections to CCLD on/before 9/16/2022.
Exit interview conducted and a copy of this report provided.

SUPERVISOR'S NAME: Harpreet Humpal	TELEPHONE: (510) 285-3928
LICENSING EVALUATOR NAME: Grace Luk	TELEPHONE: (510) 286-4201
LICENSING EVALUATOR SIGNATURE:	DATE: 08/18/2022

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/18/2022

LIC809 (FAS) - (06/04)

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