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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 075600578
Report Date: 01/16/2025
Date Signed: 01/16/2025 11:06:32 AM

Document Has Been Signed on 01/16/2025 11:06 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
CCLD Regional Office, 1515 CLAY STREET, STE. 310
OAKLAND, CA 94612
FACILITY NAME:CONCORD ROYALEFACILITY NUMBER:
075600578
ADMINISTRATOR/
DIRECTOR:		KUHLMANN, MARIA CONNIEFACILITY TYPE:
740
ADDRESS:4230 CLAYTON ROADTELEPHONE:
(925) 676-3410
CITY:CONCORDSTATE: CAZIP CODE:
94521
CAPACITY: 160TOTAL ENROLLED CHILDREN: 0CENSUS: 86DATE:
01/16/2025
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:00 AM
MET WITH:Maria Connie Kuhlmann, Executive Director TIME VISIT/
INSPECTION COMPLETED:
11:20 AM
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LPA K. Nguyen conducted an unannounced case management visit due to an unusual incident report (UIR) to CCLD received on 1/8/25. LPA met with Executive Director (ED), Connie Kuhlmann and explain the purpose of the visit.

LPA interview S1 regarding the unusual incident report received on 1/8/25 regrading R1 got admitted to the hospital due to R1 have no urine output. S1 stated that when R1 was admitted to the facility R1 had this problem before. We have caregiver check on R1 twice a day and develop a routine for R1. Any unusually that R1 have with R1 catheter or urine coloration need to informed med-tech right away and sent them to the emergency right away. S1 spoke with R1 daughter and confirmed that R1 is doing okay, but R1 is still weak and is still recovering. LPA reviewed R1 physician report and needs/ service plan showed that R1 have a second diagnosed with urinary retention requiring foley catheter. S1 will update R1 needs and service plan when R1 return to the facility.

No deficiency issue on today date.


Exit interview conducted and copy of this report provided to ED, Connie Kuhlmann.
Bennett FongTELEPHONE: (510) 725-7919
Kelly NguyenTELEPHONE: (510) 915-8702
DATE: 01/16/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/16/2025
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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