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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 019201255
Report Date: 07/16/2024
Date Signed: 07/16/2024 02:40:09 PM

Document Has Been Signed on 07/16/2024 02:40 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
OAKLAND ASC, 1515 CLAY STREET, STE. 310
OAKLAND, CA 94612
FACILITY NAME:DONOHUE CARE HOMEFACILITY NUMBER:
019201255
ADMINISTRATOR/
DIRECTOR:		YOUNG, KIMFACILITY TYPE:
735
ADDRESS:7513 DONOHUE DRTELEPHONE:
(510) 909-3458
CITY:DUBLINSTATE: CAZIP CODE:
94568
CAPACITY: 3CENSUS: 0DATE:
07/16/2024
TYPE OF VISIT:Required - 1 YearANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:25 PM
MET WITH:Young KimTIME VISIT/
INSPECTION COMPLETED:
03:05 PM
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On 7/16/2024 at 1:25 PM., Licensing Program Analyst (LPA) Ardalan Gharachorloo arrived announced to conduct 1-Year Annual Required inspection. LPA met with Administrator,Young Kim and explained the purpose of the visit. The facility currently has no clients in care.

LPA toured the facility including but not limited to bedrooms, bathrooms, kitchen, common area and backyard. All outdoor and indoor passageways are kept free of obstruction. A comfortable temperature is maintained at 74 -degree Fahrenheit. LPA observed lighting in all rooms are adequate. Hot water temperature in the shared clients’ bathroom was measured at 117.5 -degree Fahrenheit. All toilets, hand washing, and bathing are safe, sanitary and in operating condition. The supply of extra hygiene was available. There is a minimum of one-week supply of non-perishables and 2-day perishables food supply.

Smoke detectors and carbon monoxide were in operating condition during visit. Fire extinguisher was last serviced on 09/01/2023. Emergency Disaster Plan was prepared. First aid kit was observed to be complete.

The facility currently has no clients. Young Kim is the owner and administrator. LPA reviewed the administrator's file.

No deficiencies were cited during this inspection. Exit interview conducted and a copy of this report provided.
SUPERVISORS NAME: Yvonne Flores-Larios
LICENSING EVALUATOR NAME: Ardalan Gharachorloo
LICENSING EVALUATOR SIGNATURE: DATE: 07/03/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/03/2024
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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