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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 071441228
Report Date: 07/18/2023
Date Signed: 07/18/2023 11:54:34 AM

Document Has Been Signed on 07/18/2023 11:54 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
E BAY DELTA AC/SC, 1515 CLAY STREET, STE. 310
OAKLAND, CA 94612
FACILITY NAME:CAP - CONCORDFACILITY NUMBER:
071441228
ADMINISTRATOR:MCCRARY, CAROL ANNEFACILITY TYPE:
775
ADDRESS:4615 CLAYTON ROADTELEPHONE:
(925) 685-9742
CITY:CONCORDSTATE: CAZIP CODE:
94521
CAPACITY: 38CENSUS: 19DATE:
07/18/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:05 AM
MET WITH:Jamie Barber, Program CoordinatorTIME COMPLETED:
12:05 PM
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On 07/18/2023 at 9:05 AM, Licensing Program Analyst (LPA) P. Watson arrived unannounced to Required 1 Year Annual inspection. LPA met with Program Director, Jamie Barber and explained the purpose of the visit. Day program operates from 8:00 AM - 3:30 PM.

LPA toured facility with Jamie including but not limited to, multiple activity rooms, kitchen, bathrooms, and office spaces. Participants bring their own lunches and snacks. Day program also provides snacks. Emergency supplies, including water were observed. Cleaning supplies and medications are locked and inaccessible. Comfortable temperature was maintained at 71 degrees Fahrenheit inside the day program. Restrooms were observed clean and sanitary. The hot water temperature in the bathroom measured 115.2 degrees Fahrenheit. Incontinent participants are kept clean and dry, and the facility is free of odors. The program has 6 vans used for community outings, pick ups and drop offs. Emergency disaster drills are conducted monthly. Fire extinguishers throughout facility were last inspected 4/14/2023. First aid kit was complete.

At 9:25 AM, LPA reviewed 6 participant records. At 10:00 AM, LPA reviewed 6 of 10 staff records and 6 of 6 staff have first aid training and associated to the facility.

The following forms to be updated and submitted to CCL by 08/08/2023:

LIC 308 Designation of Administrative Responsibility
LIC 309 Administrative Organization
LIC 610 Emergency Disaster Plan

No deficiencies cited during visit. Exit interview conducted and a copy of this report provided.
SUPERVISORS NAME: Yvonne Flores-Larios
LICENSING EVALUATOR NAME: Paris Watson
LICENSING EVALUATOR SIGNATURE: DATE: 07/18/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/18/2023
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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