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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 075601352
Report Date: 10/18/2024
Date Signed: 10/18/2024 04:11:50 PM

Document Has Been Signed on 10/18/2024 04:11 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
OAKLAND ASC, 1515 CLAY STREET, STE. 310
OAKLAND, CA 94612
FACILITY NAME:PENNY'S GUEST HOMEFACILITY NUMBER:
075601352
ADMINISTRATOR/
DIRECTOR:
SILAGON, ROSELIERFACILITY TYPE:
740
ADDRESS:1751 ALRAY DRIVETELEPHONE:
(925) 609-8313
CITY:CONCORDSTATE: CAZIP CODE:
94521
CAPACITY: 6TOTAL ENROLLED CHILDREN: 0CENSUS: 6DATE:
10/18/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
02:40 PM
MET WITH:Licensee, Josefina "Penny" GardnerTIME VISIT/
INSPECTION COMPLETED:
04:28 PM
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On 10/18/2024 at 2:40 PM, Licensing Program Analyst (LPA) A. Gomez arrived unannounced to conduct Required 1 Year Annual inspection. Upon arrival LPA was greeted by Caregiver, Rosemarie Estrada. Licensee arrived at 1:20 PM. LPA met with Licensee, Josefina "Penny" Gardner and explained the purpose of the visit. The facility’s fire clearance was approved for 5 Non-Ambulatory and 1 Bedridden in room 5 only.

LPA toured facility with Penny including but not limited to bedrooms, bathrooms, kitchen, common area and backyard. The facility consists of 8 total bedrooms which 6 bedrooms are occupied by the residents and 2 bedroom is occupied by staff. All outdoor and indoor passageways are kept free of obstruction. There are no bodies of water observed. A comfortable temperature is maintained at 73 degrees Fahrenheit. LPA observed lighting in all rooms are adequate for the comfort and safety of the residents. The hot water temperature in the residents’ shared bathroom was measured at 114.2 degrees Fahrenheit. Residents’ bathrooms are equipped with grab bars and non-skid mats. There is a minimum 7 day supply of nonperishable and 2 day of perishable foods. Centrally stored medication and sharps were locked and inaccessible to residents.

Smoke detectors and carbon monoxide detectors were in operating condition during visit. Fire extinguisher was last purchased on 10/18/2024. First aid kit was observed to be complete. Fire drill was last conducted on 07/23/2024. Emergency Disaster plan last reviewed on 10/18/2024.

At 3:00 PM, LPA reviewed 6 of 6 residents records. At 1:50 PM, LPA reviewed 3 staff records and 3 of 3 have current first aid training and associated to the facility.

No deficiencies cited during visit. Exit interview conducted and a copy of this report provided
Yvonne Flores-LariosTELEPHONE: (510) -28-0517
Alona GomezTELEPHONE: 510-239-1306
DATE: 10/18/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/18/2024
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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