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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 019201200
Report Date: 10/27/2022
Date Signed: 10/27/2022 04:06:14 PM

Document Has Been Signed on 10/27/2022 04:06 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:OHANA HOME CAREFACILITY NUMBER:
019201200
ADMINISTRATOR:RIEZA, DEBBIEFACILITY TYPE:
735
ADDRESS:2424 ALMADEN BLVDTELEPHONE:
(925) 872-6836
CITY:UNION CITYSTATE: CAZIP CODE:
94587
CAPACITY: 4CENSUS: 4DATE:
10/27/2022
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
11:45 AM
MET WITH:Debbie Rieza, Administrator/ ApplicantTIME COMPLETED:
02:00 PM
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On 10/27/2022 at 11:45AM, Licensing Program Analyst (LPA) G. Luk conducted an unannounced Pre-licensing Inspection. LPA met with care staff, Irish Arenas. Administrator/ Applicant, Debbie Rieza arrived 30 minutes later.

LPA inspected the facility inside and out including but not limited to bedrooms, bathrooms, dining room, kitchen, living room, garage, and outdoor area. Facility has a 7-day non-perishable and 2-day perishable food supply. Medications were centrally stored in a locked closet. Home is clean and well ventilated with appropriate lighting. No bodies of water were observed. Indoor and outdoor passageways were free of obstruction.

Fire extinguisher was serviced on 5/6/2022. Smoke and carbon monoxide detectors were observed. First aid kit was complete.

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

1. LPA observed screen door was broken and room 2's closet doors were off track.

2. LPA observed C4 has a full bed rail and C4 is not on hospice care. Administrator have contacted equipment company to obtain half bed rails for C4.

3. LPA measured hot water at 138.8 degrees F in the hallway bathroom sink.

Administrator/ applicant will submit proof of corrections to CCLD on/before 11/4/2022.



Exit interview conducted with Debbie Rieza and a copy of this report provided.
SUPERVISORS NAME: Harpreet Humpal
LICENSING EVALUATOR NAME: Grace Luk
LICENSING EVALUATOR SIGNATURE: DATE: 10/27/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/27/2022
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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