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

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 075601531
Report Date: 12/28/2020
Date Signed: 12/28/2020 03:45:51 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:M&E CARE, LLCFACILITY NUMBER:
075601531
ADMINISTRATOR:DELOS SANTOS, MARIA T.FACILITY TYPE:
740
ADDRESS:461 LIMERICK ROADTELEPHONE:
(510) 669-5015
CITY:PINOLESTATE: CAZIP CODE:
94564
CAPACITY:6CENSUS: 4DATE:
12/28/2020
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH:Maria DeLos Santos, AdministratorTIME COMPLETED:
03:30 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 12/28/2020 at 1:00PM, Licensing Program Analyst (LPA) G. Luk conducted a Tele-visit Pre-Licensing inspection via FaceTime due to shelter in place directed by the Governor. This visit was conducted as a result of a change of ownership. LPA spoke with Administrator, Maria DeLos Santos.

The facility's fire clearance was approved for 4 non-ambulatory and 2 bedridden residents.

During the Tele-Inspection, LPA toured facility with Administrator including but not limited to bedrooms, bathroom, common areas, kitchen, garage and outdoor area.


At 1:45PM, LPA observed side gate was locked. Administrator removed the lock during inspection.

The deficiency was observed (see LIC 809D) and cited from the California Code of Regulations, Title 22. Failure to correct deficiency may result in civil penalties.

Exit interview conducted and a copy of this report & appeal rights will be emailed.
SUPERVISOR'S NAME: Harpreet HumpalTELEPHONE: (510) 285-3928
LICENSING EVALUATOR NAME: Grace LukTELEPHONE: (510) 286-4201
LICENSING EVALUATOR SIGNATURE:

DATE: 12/28/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/28/2020
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 2
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1515 CLAY STREET, STE. 310
OAKLAND, CA 94612

FACILITY NAME: M&E CARE, LLC
FACILITY NUMBER: 075601531
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/28/2020
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
12/29/2020
Section Cited

1
2
3
4
5
6
7
Care of Persons with Dementia. Locked exterior doors or perimeter fences with locked gates shall not substitute for...care and supervision ... This requirement is not met as evidence by:
8
9
10
11
12
13
14
Based on observation, facility did not comply with section cited above to keep exterior doors and side gate free from locks which poses an immediate health and safety risk to the residents in care.
8
9
10
11
12
13
14

1
2
3
4
5
6
7

1
2
3
4
5
6
7
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME: Harpreet HumpalTELEPHONE: (510) 285-3928
LICENSING EVALUATOR NAME: Grace LukTELEPHONE: (510) 286-4201
LICENSING EVALUATOR SIGNATURE:
DATE: 12/28/2020
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/28/2020
LIC809 (FAS) - (06/04)
Page: 2 of 2