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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 075601212
Report Date: 09/26/2022
Date Signed: 09/26/2022 03:03:18 PM


Document Has Been Signed on 09/26/2022 03:03 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:ST. FRANCIS CARE HOME IIFACILITY NUMBER:
075601212
ADMINISTRATOR:BUCCAT, EDWINFACILITY TYPE:
740
ADDRESS:3546 CONCORD BLVD.TELEPHONE:
(925) 798-2104
CITY:CONCORDSTATE: CAZIP CODE:
94519
CAPACITY:6CENSUS: 4DATE:
09/26/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
01:38 PM
MET WITH:Purificacion Lominari, staffTIME COMPLETED:
03:12 PM
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On 09/26/2022 at 01:17 PM Licensing Program Analysts (LPA) J. Clancy-Czuleger conducted a Case Management. LPA met with Purificacion Lominari, staff.

While at the facility for an annual inspection LPA observed that one of the residents (R1) has a foul odder. Staff explained that they are concerned that R1 does not bathe and does not want assistance to bathe. They also explained that R1 does not want staff to clean his room. The staff are worried that they will not have a healthy/safe environment for R2 who shares a room with R1. Staff state that they clean R2's side of the room but there is still an odder from R1's side.

Based on record review, R1's file states that he does not need assistance with bathing and that he has an allergy to soap so he will bathe himself using water and a sponge.

LPA discussed with the staff that it is R1's personal right to refuse assistance for bathing, But that it is R2's personal right to have a clean odder free space to live, which allows the staff the assist with cleaning the room.

Exit interview conducted. A copy of this report provided.
SUPERVISOR'S NAME: Harpreet HumpalTELEPHONE: (510) 285-3928
LICENSING EVALUATOR NAME: Jill Clancy-CzulegerTELEPHONE: 510-286-4201
LICENSING EVALUATOR SIGNATURE:
DATE: 09/26/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/26/2022
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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