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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 019201200
Report Date: 01/30/2024
Date Signed: 01/30/2024 01:48:23 PM

Document Has Been Signed on 01/30/2024 01:48 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: 3DATE:
01/30/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:10 AM
MET WITH:Debbie RiezaTIME COMPLETED:
01:45 PM
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Licensing Program Analyst (LPA) Luisa Fontanilla arrived unannounced to conduct an annual required inspection and met with Administrator Debbie Rieza. LPA explained to the Administrator the purpose of the visit.

The facility is a Level 4C home vendorized by the Regional Center of the East Bay (RCEB). It is licensed to admit 4 non ambulatory clients. There were no clients and other staff observed upon arrival. The Administrator states all clients are in the day program. LPA inspected the facility inside and out including but not limited to bedrooms, bathrooms, dining area, kitchen, living room, garage, and outdoor area. Facility was observed to have a 7-day non-perishable and 2-day perishable food supplies. Medications were centrally stored in a locked closet. Hot water measured at 105 degrees Fahrenheit. The facility was observed to be clean, odor free and has appropriate lighting. No bodies of water were observed. Indoor and outdoor passageways were free of obstruction. Client 1 (C1) arrived at 12:40 pm.
Fire extinguisher was serviced on 5/30/2023. Dual smoke and carbon monoxide detectors were tested and observed operational. First aid kit was complete.

At 11am, LPA reviewed 3 staff files and 3 client files. All staff are fingerprint cleared and associated to the facility. They have current First aid/CPR training. At 12:15 PM, LPA reviewed medication and Medication Administration Record (MAR). At 12:33 pm, LPA reviewed P&I money and log. LPA interviewed C1 and Administrator during the visit.

There were no deficiencies noted during this visit.

A copy of this report was provided to the Administrator,

SUPERVISORS NAME: Yvonne Flores-Larios
LICENSING EVALUATOR NAME: Luisa Fontanilla
LICENSING EVALUATOR SIGNATURE: DATE: 01/30/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/30/2024
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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