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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 075600928
Report Date: 01/02/2025
Date Signed: 01/02/2025 01:26:45 PM

Document Has Been Signed on 01/02/2025 01:26 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:LAFAYETTE HEIGHTS RES. CAREFACILITY NUMBER:
075600928
ADMINISTRATOR/
DIRECTOR:		MOGADAM, JOANNEFACILITY TYPE:
740
ADDRESS:34 CAMINO JUSTINTELEPHONE:
(925) 979-1200
CITY:LAFAYETTESTATE: CAZIP CODE:
94549
CAPACITY: 6TOTAL ENROLLED CHILDREN: 0CENSUS: 5DATE:
01/02/2025
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:20 AM
MET WITH:Licensee Joanne MogadamTIME VISIT/
INSPECTION COMPLETED:
01:45 PM
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On 01/20/2024 at 10:20 AM, Licensing Program Analyst (LPA) D. Doidge arrived unannounced to conduct the Required Annual Inspection of the facility. Upon arrival, LPA stated the purpose of the visit to Maria Elizabeth Agbulos, Caregiver. Licensee Joanne Mogadam arrived at 10:30 AM.

LPA toured the facility including but not limit to, bedrooms, bathrooms, multiple activity rooms, kitchen, common area and backyard. LPA observe lighting in all rooms are adequate for the comfort and safety of the residents. Hallway temperature was maintained at 72 degrees Fahrenheit. The hot water temperature in a common bathroom was measured at 115 degrees Fahrenheit. There is a minimum of one week supply of nonperishable and 2-day of perishable foods. Centrally stored medications, sharps are locked and inaccessible to residents in care.

Smoke detectors and carbon monoxide detectors were in operating condition during visit. Fire extinguisher was last serviced on 01/04/2024. Emergency disaster drill was last conducted on 12/20/2024, they are conducted quarterly. First aid kit was observed to be complete.

LPA reviewed five (5) resident records and three (3) staff records. All but 1 of resident records are missing LIC613-C. Technical Assistance issued. Staff records are complete..

No deficiencies observed or cited during this visit.

Exit interview conducted and a copy of this report provided
Bennett FongTELEPHONE: (510) 286-4201
David DoidgeTELEPHONE: (916) 475-5913
DATE: 01/02/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/02/2025
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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