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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 075601035
Report Date: 08/17/2022
Date Signed: 08/17/2022 11:06:26 AM

Document Has Been Signed on 08/17/2022 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:CARRIAGE CAREFACILITY NUMBER:
075601035
ADMINISTRATOR:TUAZON, GABRIEL & ERLINDAFACILITY TYPE:
740
ADDRESS:1959 CARRIAGE DRIVETELEPHONE:
(925) 977-9678
CITY:WALNUT CREEKSTATE: CAZIP CODE:
94598
CAPACITY: 6CENSUS: 5DATE:
08/17/2022
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Erlinda TuazonTIME COMPLETED:
11:30 AM
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On 08/17/22 at 9:00 AM, Licensing Program Analyst (LPA) J. Sampair conducted a Plan of Correction inspection. Upon entry into facility, LPA explained the purpose of the visit with Licensee Erlinda Tuazon.

This visit was prompted by the licensee's failure to provide documentation to the LPA that the citation from 8/3/22 had been corrected. When interviewed by LPA, the licensee stated that she had neither reviewed donning and doffing PPE videos from CDC with all of the licensee's staff members nor had she reviewed her Infection Control Plan in its entirety.

Failure to correct that deficiency has resulted in a civil penalty (see LIC 421FC).

Exit interview conducted and appeal rights provided to Licensee.
SUPERVISORS NAME: Harpreet Humpal
LICENSING EVALUATOR NAME: James Sampair
LICENSING EVALUATOR SIGNATURE: DATE: 08/17/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/17/2022
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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