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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 075600076
Report Date: 08/09/2022
Date Signed: 08/09/2022 02:24:44 PM


Document Has Been Signed on 08/09/2022 02:24 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
E BAY DELTA AC/SC, 1515 CLAY STREET, STE. 310
OAKLAND, CA 94612



FACILITY NAME:HAPPY VALLEY-HOME FOR OUR PARENTSFACILITY NUMBER:
075600076
ADMINISTRATOR:ONOFREI, NICOLAEFACILITY TYPE:
740
ADDRESS:3292 WALNUT LANETELEPHONE:
(925) 284-4846
CITY:LAFAYETTESTATE: CAZIP CODE:
94549
CAPACITY:6CENSUS: 5DATE:
08/09/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
09:40 AM
MET WITH:Nicolae & Damaris Onofrei, AdministratorsTIME COMPLETED:
02:40 PM
NARRATIVE
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On 8/9/22 at 9:40 AM, Licensing Program Analyst (LPA) C. Lin conducted an unannounced case management visit of health and safety check regarding the previous deficiencies. LPA met with the both Administrators and explained the purpose of the visit. .

Upon entry, LPA observed that S1 and S2 who still haven't had CCL criminal background check clearance were working at facility. Administrators stated when DOJ clearances were received, they assumed that the staff were able to work. LPA reviewed the live-Scan form and observed that facility name and number were not filled out correctly. LPA advised Administrators that both of staff have not been cleared in Guardian. Administrator also stated that they were not familiar with Guardian Portal.

LPA printed out regulations 87355 - Criminal Record Clearance and 87405-Administrator Qualification for Administrator to review. Plan and proof of correction was discussed with Administrators. LPA allowed two uncleared staff to continue working in facility but have to be supervised by cleared staff at all time until they are cleared by CCL, both Administrators agreed to comply.

Deficiency is cited per Title 22 California Code of Regulations and listed on LIC809D. Failure to submit proofs of correction (POC) by plan of correction due date and/or any repeat deficiencies within a 12-month period may result in additional civil penalties.

Exit interview conducted. Appeal Rights and a copy of this report provided.

SUPERVISOR'S NAME: Bennett FongTELEPHONE: (510) 622-2621
LICENSING EVALUATOR NAME: Catherine LinTELEPHONE: 510-622-2053
LICENSING EVALUATOR SIGNATURE:
DATE: 08/09/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/09/2022
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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Document Has Been Signed on 08/09/2022 02:24 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
E BAY DELTA AC/SC, 1515 CLAY STREET, STE. 310
OAKLAND, CA 94612


FACILITY NAME: HAPPY VALLEY-HOME FOR OUR PARENTS
FACILITY NUMBER: 075600076

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/09/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
08/10/2022
Section Cited

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87355 Criminal Record Clearance
(e)All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1569.17(b) shall prior to working, residing or volunteering in a licensed facility:
(1) Obtain a California clearance or a criminal record exemption as required by the Department.

This requirement is not met as evidenced by:
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Based on observation, interview, and record review, the licensee did not comply with the section cited above in two caregivers returned to work on 7/18/2022 without having CCL criminal background clearance which poses an immediate health, safety or personal rights risk to persons in care.
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Type B
08/16/2022
Section Cited

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87405 Administrator - Qualifications and Duties
(h) The administrator shall have the responsibility to:
(1) Administer the facility in accordance with these regulations and established policy....

This requirement is not met as evidenced by:
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Based on observation, interview, and record review, the licensee did not comply with the section cited above. LPA observed that Administrators were not familiar with Guardian Portal which posed a potential health, safety or personal rights risk to persons in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME: Bennett FongTELEPHONE: (510) 622-2621
LICENSING EVALUATOR NAME: Catherine LinTELEPHONE: 510-622-2053
LICENSING EVALUATOR SIGNATURE:
DATE: 08/09/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/09/2022
LIC809 (FAS) - (06/04)
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