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

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 075601371
Report Date: 08/16/2023
Date Signed: 08/16/2023 02:01:53 PM


Document Has Been Signed on 08/16/2023 02:01 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:LAFAYETTE CARE HOME IIFACILITY NUMBER:
075601371
ADMINISTRATOR:LI KURIHARA, LINDAFACILITY TYPE:
740
ADDRESS:22 CAMINO COURTTELEPHONE:
(925) 930-8860
CITY:LAFAYETTESTATE: CAZIP CODE:
94549
CAPACITY:6CENSUS: 0DATE:
08/16/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
12:20 PM
MET WITH:Linda KuriharaTIME COMPLETED:
02:15 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 this day at around 12:20 pm, Licensing Program Analyst (LPA) Luisa Fontanilla arrived at the facility. LPA rang the door bell and knocked on the door a few times but no one answered the door. LPA spoke with Administrator Linda Kurihara over the phone. She states that the facility does not have any resident. And that the last resident moved out in September 2022. Administrator states the facility has been under renovation since September 2022. LPA explained to the Administrator that an inspection still needs to be completed even if there are no residents as long as the license is active. Administrator arrived at 12:55 pm.

Facility has submitted an infection control plan.

During the visit, LPA did not observe any resident at the facility. Different construction materials were observed throughout the facility. Administrator states all the files are kept in the other licensed facility she owns. No staff and resident interviews were conducted.

Administrator states it might take three more months to complete the renovation. She also states that she wants to keep the license but is not interested in accepting any resident after the renovation. She states there is someone who is interested in buying the property. LPA advised the Administrator to notify CCL once she has decided to sell the house/surrender the license so CCL can schedule a closure visit.

A copy of this report was provided to the Administrator
SUPERVISOR'S NAME: Yvonne Flores-LariosTELEPHONE: (510) 286-0517
LICENSING EVALUATOR NAME: Luisa FontanillaTELEPHONE: (510) 286-7147
LICENSING EVALUATOR SIGNATURE:
DATE: 08/16/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/16/2023
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