<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 075601290
Report Date: 06/23/2020
Date Signed: 06/23/2020 12:54:32 PM

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:LA ORINDA CARE HOMEFACILITY NUMBER:
075601290
ADMINISTRATOR:WONG, RONALD G.FACILITY TYPE:
740
ADDRESS:2180 LA ORINDA PLACETELEPHONE:
(925) 798-3570
CITY:CONCORDSTATE: CAZIP CODE:
94518
CAPACITY:6CENSUS: 4DATE:
06/23/2020
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
12:39 PM
MET WITH:Ronald Wong, AdministratorTIME COMPLETED:
01:00 PM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
On 06/23/20 at 1:00 PM, Licensing Program Analyst (LPA) D Panlilio called to conduct a health and safety check via tele-visit as a result of the department receiving a priority 1 complaint. LPA explained the face time tele-visit with Administrator who was physically unavailable to sign this report due to COVID-19 shelter in place order issued by the CA governor on March 17,2020.

During health and safety check, LPA observed a total of 2 staff members and 3 residents at the facility.

LPA toured the facility with Administrator including but not limited to bedrooms, kitchen, bathroom, and common areas. Residents in care appear to be safe and there are no imminent health/safety concerns on today's date.

No deficiencies were cited during this health and safety check. Exit interview conducted and a copy of this report provided.
SUPERVISOR'S NAME: Rajind BasiTELEPHONE: (510) 286-4201
LICENSING EVALUATOR NAME: Daisy PanlilioTELEPHONE: (510) 286-4201
LICENSING EVALUATOR SIGNATURE:

DATE: 06/23/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/23/2020
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 1