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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 071441228
Report Date: 07/19/2024
Date Signed: 07/19/2024 12:30:53 PM

Document Has Been Signed on 07/19/2024 12:30 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:CAP - CONCORDFACILITY NUMBER:
071441228
ADMINISTRATOR/
DIRECTOR:
MCCRARY, CAROL ANNEFACILITY TYPE:
775
ADDRESS:4615 CLAYTON ROADTELEPHONE:
(925) 685-9742
CITY:CONCORDSTATE: CAZIP CODE:
94521
CAPACITY: 38CENSUS: 20DATE:
07/19/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
11:00 AM
MET WITH:Jamie Barber, Program Coordinator (PC)TIME VISIT/
INSPECTION COMPLETED:
01:00 PM
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On 07/19/24 at 11 AM, Licensing Program Analyst (LPA) D Panlilio arrived unannounced to conduct a required 1 year annual inspection. LPA met with Program Coordinator and explained the purpose of the visit. Day program operates from 8:00 AM - 3:30 PM Monday to Friday.

At 11:10AM, LPA toured the facility with PC including but not limited to two activity rooms, sensory room, relaxation/medication room, kitchen, 4 bathrooms, dining room and office spaces. Participants bring their own lunches and snacks. Day program also provides snacks. Emergency supplies, including water were observed stored in a locked storage room. Cleaning supplies and medications are locked and inaccessible. Comfortable temperature at the facility was maintained at 70 deg F. Restrooms were observed clean and sanitary. The hot water temperature in the bathroom measured 106 degrees Fahrenheit. Incontinent participants are kept clean and dry, and the facility is free of odors. The program has 4 vans used for community outings, pick ups and drop offs. Emergency disaster drills are conducted monthly. Fire extinguishers throughout facility were last inspected 4/11/24. First aid kit was observed complete.

At 12PM, LPA reviewed 5 participant and staff records.

LPA obtained the following documents during visit:
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: Bennett Fong
LICENSING EVALUATOR NAME: Daisy Panlilio
LICENSING EVALUATOR SIGNATURE: DATE: 07/19/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/19/2024
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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