075600632-10-31-2023-15-AS-LAWN-CWS5L3-20231019200228

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 075600632
Report Date: 10/19/2023
Date Signed: 10/31/2023 05:03:55 PM

Document Has Been Signed on 10/31/2023 05:03 PM - It Cannot Be Edited

Document is an Amendment of Original Document on 10/25/2023 03:11 PM

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

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	This is an Amendment to an Original 809 generated on 10/19/2023. On 10/19/2023 Licensing Program Analyst (LPA) L. Alexander conducted an unannounced Case Management visit regarding an incident that was self-reported to CCLD on 10/16/2023. There is a pending application for new ownership. The Licensee reported that the pending new licensees hired 2 caregivers that were not fingerprint cleared. LPA met with Caregiver, Oscar Santos and explained the purpose of the visit. The Administrator/Licensee, Estrellita Cruz, was not available. However, LPA L. Alexander spoke with Estrellita on the phone. LPA found that S4 and S5 were not on the facility's association roster, and could not be found in the background check system. A LIC809-C Continued....

SUPERVISOR'S NAME: Bennett Fong	TELEPHONE: (510) 725-7919
LICENSING EVALUATOR NAME: Lori Alexander-Washington	TELEPHONE: (510) 285-3934
LICENSING EVALUATOR SIGNATURE:	DATE: 10/19/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/19/2023

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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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: TENDER TOUCH RESIDENTIAL CARE HOME	FACILITY NUMBER: 075600632
	VISIT DATE: 10/19/2023

NARRATIVE

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LIC809 Continued.....
citation was issued a civil penalty was assessed. On 10/20/23, the pending applicants provided to LPA letters from CCLD stating that S4 and S5 were fingerprint cleared. LPA contacted the business unit that handles fingerprint clearance and was informed that S4 and S5 were cleared. Therefore the deficiency and civil penalty are removed.

During the Case Management visit, LPA observed LPA that a bed mattress was set-up in the garage for staff to sleep on. S2 confirmed that S2 is sleeping overnights in the garage

LPA observed file cabinets, boxes, lamps, paint buckets, totes, bleach bottle, lamps, cabinets located outside at the side yard and back patio.

LPA observed Fabuloso cleaner, Lysol cans unlocked in the garage.

The deficiencies were observed (see LIC809D) and cited from the California Code of Regulation, Title 22. Failure to correct the deficiencies may result in civil penalties.

Exit interview conducted. A copy of this report and appeal rights provided

SUPERVISOR'S NAME: Bennett Fong	TELEPHONE: (510) 725-7919
LICENSING EVALUATOR NAME: Lori Alexander-Washington	TELEPHONE: (510) 285-3934
LICENSING EVALUATOR SIGNATURE:	DATE: 10/19/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/19/2023

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 10/31/2023 05:10 PM - It Cannot Be Edited

Document is an Amendment of Original Document on 10/25/2023 03:42 PM

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: TENDER TOUCH RESIDENTIAL CARE HOME	FACILITY NUMBER: 075600632
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 10/19/2023

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
	1 2 3 4 5 6 7		1 2 3 4 5 6 7
	8 9 10 11 12 13 14		8 9 10 11 12 13 14
Type A 10/20/2023 Section Cited CCR87202(a)	1 2 3 4 5 6 7	Fire Clearance: All facilities shall be maintained in conformity with the regulations... This requirement is not met as evidenced by:	1 2 3 4 5 6 7	Administrator will remove the bed from the garage and submit a photo to CCLD by POC Due Date.
	8 9 10 11 12 13 14	Based on observation and interview, the licensee did not comply with the section cited above by having a bed in the garage. LPA learned S2 slept in the garage overnight.	8 9 10 11 12 13 14	Immediate $500.00 Civil Penalty assessed.

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 Fong	TELEPHONE: (510) 725-7919
LICENSING EVALUATOR NAME: Lori Alexander-Washington	TELEPHONE: (510) 285-3934
LICENSING EVALUATOR SIGNATURE:	DATE: 10/19/2023

I acknowledge receipt of this form and understand my appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/19/2023

LIC809 (FAS) - (06/04)

Page: 2 of 5

Document Has Been Signed on 10/19/2023 08:05 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: TENDER TOUCH RESIDENTIAL CARE HOME	FACILITY NUMBER: 075600632
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 10/19/2023

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 11/02/2023 Section Cited CCR 80087(a)	1 2 3 4 5 6 7	80087(a) (a) The facility shall be clean, safe, sanitary... This requirement is not met as evidenced by:	1 2 3 4 5 6 7	Administrator will remove file cabinets, boxes, lamps, paint buckets, totes, etc...and submit photos to CCLD by POC Due Date.
	8 9 10 11 12 13 14	Based on observation the Licensee did not have the side yard and back patio/deck cleaned which poses a potential health, safety or personal rights risk to persons in care.	8 9 10 11 12 13 14
	1 2 3 4 5 6 7		1 2 3 4 5 6 7
	1 2 3 4 5 6 7		1 2 3 4 5 6 7

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 Fong	TELEPHONE: (510) 725-7919
LICENSING EVALUATOR NAME: Lori Alexander-Washington	TELEPHONE: (510) 285-3934
LICENSING EVALUATOR SIGNATURE:	DATE: 10/19/2023

I acknowledge receipt of this form and understand my appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/19/2023

LIC809 (FAS) - (06/04)

Page: 4 of 5

Document Has Been Signed on 10/19/2023 08:05 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: TENDER TOUCH RESIDENTIAL CARE HOME	FACILITY NUMBER: 075600632
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 10/19/2023

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type A 10/20/2023 Section Cited CCR 80087(g)	1 2 3 4 5 6 7	80087 (g) Disinfectants, cleaning solutions...a danger if readily available to clients shall be stored where inaccessible to clients. This requirement is not met as evidenced by:	1 2 3 4 5 6 7	Administrator will remove and lock up bottles of Bleach, Fabuloso, Lysol and submit photos to CCLD by POC Due Date.
	8 9 10 11 12 13 14	Based on observation, the licensee did not comply with the section cited above by having chemicals in the garage and outside yard unlocked and accessible which poses a potential health, safety or personal rights risk to persons in care.	8 9 10 11 12 13 14
	1 2 3 4 5 6 7		1 2 3 4 5 6 7
	1 2 3 4 5 6 7		1 2 3 4 5 6 7

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 Fong	TELEPHONE: (510) 725-7919
LICENSING EVALUATOR NAME: Lori Alexander-Washington	TELEPHONE: (510) 285-3934
LICENSING EVALUATOR SIGNATURE:	DATE: 10/19/2023

I acknowledge receipt of this form and understand my appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/19/2023

LIC809 (FAS) - (06/04)

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