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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 075600206
Report Date: 09/17/2024
Date Signed: 09/17/2024 01:04:13 PM


Document Has Been Signed on 09/17/2024 01:04 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:A & A CARE HOME IFACILITY NUMBER:
075600206
ADMINISTRATOR:BORJA, AMYFACILITY TYPE:
740
ADDRESS:521 FENWAY DRIVETELEPHONE:
(925) 210-0808
CITY:WALNUT CREEKSTATE: CAZIP CODE:
94598
CAPACITY:6CENSUS: 6DATE:
09/17/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:30 AM
MET WITH:Amy Borja AdministratorTIME COMPLETED:
01:30 PM
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On 9/172024 at 10:30 AM, Licensing Program Analysts (LPAs) David Doidge and James Sampair arrived unannounced to conduct the Required Annual Inspection. Upon entry, LPAs stated the purpose of the visit to Antonita Turno, Caregiver. Administrator, Amy Borja arrived 11:00 AM.

LPAs toured the facility including but not limited to bedrooms, bathrooms, dining area, kitchen, common areas, and outdoor area. Smoke detectors and carbon monoxide detectors were observed. Fire extinguishers were observed, last serviced on 09/04/2024. Temperature in the facility was measured at 69 degrees Fahrenheit at 10:51 AM. Water temperature was 111 degrees Fahrenheit.

Grab bars for each toilet and shower were installed. Non-skid mats were observed. There were adequate lights in each room. Resident rooms were observed to be cleaned and fully furnished. Indoor and outdoor passages were free of obstruction.

The LPAs observed required postings in the facility, including the Complaint Poster, Ombudsman and Personal Rights posters, and the Theft and Loss Policy.



One week of nonperishable and 2 days of perishable food supplies were available.

Exit interview conducted and a copy of this report provided.

SUPERVISOR'S NAME: Bennett FongTELEPHONE: (510) 286-4201
LICENSING EVALUATOR NAME: David DoidgeTELEPHONE: (916) 475-5913
LICENSING EVALUATOR SIGNATURE:
DATE: 09/17/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/17/2024
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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