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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 075601236
Report Date: 09/06/2022
Date Signed: 09/06/2022 11:37:22 AM


Document Has Been Signed on 09/06/2022 11:37 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:SEIKO'S PLACEFACILITY NUMBER:
075601236
ADMINISTRATOR:LINSZKY, SEIKOFACILITY TYPE:
740
ADDRESS:4967 HAMES DRIVETELEPHONE:
(925) 676-8963
CITY:CONCORDSTATE: CAZIP CODE:
94521
CAPACITY:6CENSUS: 5DATE:
09/06/2022
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
10:53 AM
MET WITH:Gladys Corpuz, CaregiverTIME COMPLETED:
11:50 AM
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On 9/6/2022, at 10:53AM, Licensing Program Analysts (LPAs) G. Luk and P. Watson arrived unannounced to conduct proof of correction (POC) visit. LPAs met with caregiver, Gladys Corpus.

The following deficiency was cleared by visit:
- 87309(a); LPAs observed cleaning supplies were observed in a locked.

POC letter was printed and a copy was provided to caregiver.

Facility still has the following deficiency that were not cleared and were issued on 9/2/2022 from California Code of Regulations, Title 22:
- 87465(h)(2); LPAs observed lock box in the refrigerator has key on the lock and medication cabinet was unlocked. Caregiver locked up the medication cabinet and removed the key during visit.

Civil Penalties in the amount of $300 is assessed today for the period of 9/4/2022 to 9/6/2022 for failure to meet POC date for deficiency 87465(h)(2).

Exit interview conducted. A copy of this report and appeal rights provided.
SUPERVISOR'S NAME: Harpreet HumpalTELEPHONE: (510) 285-3928
LICENSING EVALUATOR NAME: Grace LukTELEPHONE: (510) 286-4201
LICENSING EVALUATOR SIGNATURE:
DATE: 09/06/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/06/2022
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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