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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 071441088
Report Date: 04/16/2024
Date Signed: 04/16/2024 08:32:28 AM

Document Has Been Signed on 04/16/2024 08:32 AM - 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:JONES FAMILY HOMEFACILITY NUMBER:
071441088
ADMINISTRATOR/
DIRECTOR:		DAVID & SHIRLEY JONESFACILITY TYPE:
735
ADDRESS:180 FRANCISCAN DRIVETELEPHONE:
(925) 838-4216
CITY:DANVILLESTATE: CAZIP CODE:
94526
CAPACITY: 6CENSUS: 3DATE:
04/16/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
07:30 AM
MET WITH:Administrator, Shirley JonesTIME VISIT/
INSPECTION COMPLETED:
08:45 AM
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Licensing Program Analyst (LPA) A. Gomez arrived unannounced on this date to conduct 1-Year Annual Inspection starting at 7:30am. Upon arrival, LPA met with Administrator, Shirley Jones. The facility's fire clearance was approved for ambulatory only.

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. There are no bodies of water. A comfortable temperature for clients is maintained at 72 degree Fahrenheit. LPA observed lighting in all rooms are adequate for the comfort and safety of the clients. Hot water temperature in the shared clients’ bathroom was measured at 117.2 degree Fahrenheit. All toilets, hand washing and bathing are safe, sanitary and in operating condition. The supply of extra hygiene were available for residents. There are a minimum of 7-day non-perishables and 2-day perishables foods.

Smoke detectors and carbon monoxide were in operating condition during visit. Fire extinguisher was last serviced on 4/14/2023 . First aid kit was observed to be complete. Disaster drill was last conducted on 1/11/2024. Emergency Disaster plan last reviewed 1/4/2024

LPA reviewed 2 staff records and staff are associated to the facility and have current first aid training. LPA reviewed 3 clients records and P&I's. Surety bond is sufficient to cover P&I.


No deficiencies cited during visit. Exit interview conducted and a copy of this report provided.


SUPERVISORS NAME: Yvonne Flores-Larios
LICENSING EVALUATOR NAME: Alona Gomez
LICENSING EVALUATOR SIGNATURE: DATE: 04/16/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/16/2024
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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