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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 075601332
Report Date: 05/12/2023
Date Signed: 05/12/2023 03:56:00 PM

Document Has Been Signed on 05/12/2023 03:56 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
E BAY DELTA AC/SC, 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: 4DATE:
05/12/2023
TYPE OF VISIT:Case Management - Annual ContinuationUNANNOUNCEDTIME BEGAN:
11:04 AM
MET WITH:Lilia Perdiguerra, LicenseeTIME COMPLETED:
04:15 PM
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On 05/12/2023 starting at 11:04 AM, Licensing Program Analyst (LPA) L. Alexander arrived unannounced to continue the 1-Year Annual Required inspection from 05/03/2023. LPA met with Licensee, Lilia Perdiguerra and explained the purpose of the visit. The Administrator, Jerry Perdiguerra, arrived shortly thereafter.

The inspection continued with reviewing 5 Staff file records, conducting 1 staff and 1 resident interview, and completing the entire CARE tool for this full inspection.

LPA toured the facility with the Administrator and observed where prior deficiencies were cited on 05/03/2023. In addition, LPA observed the additional deficiencies cleared that the Administrator repaired/completed with the recent fire inspection.

No deficiencies cited during visit. Exit interview conducted and a copy of this report provided.
SUPERVISORS NAME: Bennett Fong
LICENSING EVALUATOR NAME: Lori Alexander-Washington
LICENSING EVALUATOR SIGNATURE: DATE: 05/12/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/12/2023
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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