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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 075601205
Report Date: 02/03/2024
Date Signed: 02/03/2024 03:13:45 PM


Document Has Been Signed on 02/03/2024 03:13 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
CCLD Regional Office, 1515 CLAY STREET, STE. 310
OAKLAND, CA 94612



FACILITY NAME:MORAGA RETREAT CAREFACILITY NUMBER:
075601205
ADMINISTRATOR:BLAJ, ANAMARIAFACILITY TYPE:
740
ADDRESS:715 MORAGA ROADTELEPHONE:
(925) 376-2273
CITY:MORAGASTATE: CAZIP CODE:
94556
CAPACITY:6CENSUS: 5DATE:
02/03/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
12:05 PM
MET WITH:Anamaria BlajTIME COMPLETED:
03:20 PM
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On this day at around 12:05 PM, Licensing Program Analyst (LPA) Luisa Fontanilla arrived unannounced to conduct annual required inspection and met with staff Lizette Ng. LPA explained to Ng the purpose of the visit. The Administrator Ana Maria Blaj arrived at the facility at around 12:30pm. The Administrator holds certificate# 6006063740.

During the visit, LPA toured facility including but not limited to the kitchen, dining room, resident bedrooms and bathrooms, front and back area of the facility, and common areas. Fire extinguisher was observed full and last inspected on 5/22/23. Smoke detectors and carbon monoxide detectors were tested and observed functional. LPA observed the facility to be at a comfortable temperature for residents. All indoor and outdoor passageways are kept free of obstruction. Hot water temperature was measured at 115.8 degrees Fahrenheit. LPA observed skid mats and grab bars in resident bathrooms. LPA observed sufficient furniture and lighting throughout the facility. There are no bodies of water present in or around the facility. LPA observed a sufficient supply of 7 day non-perishables and two day perishable food supplies.

At around 12:40 pm, LPA reviewed 5 resident files and 5 staff files. All staff are fingerprint cleared and associated to the facility. All 5 staff have current first aid and CPR training. The last fire and earthquake drills were conducted on January 23, 2024. Centrally stored medications were observed locked in a cabinet. LPA interviewed 2 residents and 2 staff at around 2pm.

There are no deficiencies noted during the visit.

A copy of this report was provided to the Administrator.
SUPERVISOR'S NAME: Yvonne Flores-LariosTELEPHONE: (510) 286-0517
LICENSING EVALUATOR NAME: Luisa FontanillaTELEPHONE: (510) 286-7147
LICENSING EVALUATOR SIGNATURE:
DATE: 02/03/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/03/2024
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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