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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 075601264
Report Date: 08/19/2022
Date Signed: 08/22/2022 02:27:24 PM


Document Has Been Signed on 08/22/2022 02:27 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:TENDER TOUCH RESIDENTIAL CARE HOME IIIFACILITY NUMBER:
075601264
ADMINISTRATOR:CRUZ, ESTRELLITA S.FACILITY TYPE:
740
ADDRESS:2130 DORSCH ROADTELEPHONE:
(925) 256-6879
CITY:WALNUT CREEKSTATE: CAZIP CODE:
94598
CAPACITY:6CENSUS: 6DATE:
08/19/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
01:30 PM
MET WITH:Fe Dimaano and Rafael ConcepcionTIME COMPLETED:
04:00 PM
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On 8/19/22 at 1:30 PM, Licensing Program Analyst (LPA) J. Sampair conducted an infection control annual inspection. Upon entry, LPA explained the purpose of the visit with staff members Fe Dimaano and Rafael Concepcion. Licensee / Administrator Estrellita Cruz was contacted via phone, but she was not able to come to the facility. Instead, Ms. Dimaano and Mr. Concepcion toured the facility inside and outside and spoke about management of the facility and infection control with the LPA.

Facility has an infection control plan in place that they are following. The designated infection control leader is Fe Dimaano. They have one central entry point that has been designated for universal entry screening with the station located near the front entrance with visitor's log, hand sanitizer, face masks, and no touch thermometer. Facility follows daily cleaning, sanitation of frequently touched common surfaces with disinfectants. COVID-19 signs were posted to promote hand washing, cough/sneeze etiquette and physical distancing.

A written Emergency/Disaster plan was in the Disaster Plan binder. Centrally stored medications were in locked cabinets. The temperature inside of the facility was 79.7 and the hot water was 110 degrees Fahrenheit, both of which were in the safe range. Toxic chemicals and sharp objects were stored in locked closets and cabinets. Carbon monoxide and smoke detectors were fully functional and the fire extinguisher had been serviced within one (1) year and it was fully charged. An administrator is on site more than the required 20 hour minimum each week to oversee business operations.

Continues on LIC 809-C . . .
SUPERVISOR'S NAME: Harpreet HumpalTELEPHONE: (510) 285-3928
LICENSING EVALUATOR NAME: James SampairTELEPHONE: (510) 286-4201
LICENSING EVALUATOR SIGNATURE:
DATE: 08/19/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/19/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 2


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1515 CLAY STREET, STE. 310
OAKLAND, CA 94612
FACILITY NAME: TENDER TOUCH RESIDENTIAL CARE HOME III
FACILITY NUMBER: 075601264
VISIT DATE: 08/19/2022
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. . . Continued from LIC 809

Updated copies of the following documents were requested for facility file and are to be submitted to CCL on or before 08/26/22:

· LIC500 - Personnel Report
· LIC308 - Designation of Facility Responsibility
· LIC610E - Emergency/Disaster Plan
· Evidence of Liability Insurance

No deficiencies cited during this visit. Exit interview conducted and a copy of this report provided via email.
SUPERVISOR'S NAME: Harpreet HumpalTELEPHONE: (510) 285-3928
LICENSING EVALUATOR NAME: James SampairTELEPHONE: (510) 286-4201
LICENSING EVALUATOR SIGNATURE:

DATE: 08/19/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/19/2022
LIC809 (FAS) - (06/04)
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