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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 075601332
Report Date: 01/20/2021
Date Signed: 01/20/2021 04:36:18 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:BOYD SENIOR CARE HOMEFACILITY NUMBER:
075601332
ADMINISTRATOR:PERDIGUERRA, LILIAFACILITY TYPE:
740
ADDRESS:345 BOYD ROADTELEPHONE:
(925) 256-6500
CITY:PLEASANT HILLSTATE: CAZIP CODE:
94523
CAPACITY:6CENSUS: 5DATE:
01/20/2021
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
12:45 PM
MET WITH:Lilia Perdiguerra/Licensee-Administrator and
Jerry Perdiguerra/Assistant Administrator		TIME COMPLETED:
01:45 PM
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Licensing Program Analyst (LPA) Delmundo conducted a health and safety inspection as a result of the Department receiving a complaint (Control # 15-AS-20210115122146). LPA explained to Lilia Perdiguerra (licensee-administrator) and Jerry Perdiguerra (assistant administrator) that due to the present Shelter in Place Order by the Governor, inspection will be done via video conference.

LPA requested Lilia Perdiguerra and Jerry Perdiguerra to tour LPA to the facility. LPA inspected all ot the residents bedrooms, living room, dining area, kitchen and staff's office area. LPA also met with 5 residents.

No citation issued on this day.

Exit interview conducted and copy of this report provided to the licensee via e-mail.
SUPERVISOR'S NAME: Isaac TaggartTELEPHONE: (510) 363-5912
LICENSING EVALUATOR NAME: Alicia DelmundoTELEPHONE: (510) 286-4201
LICENSING EVALUATOR SIGNATURE:

DATE: 01/20/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/20/2021
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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