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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 075601572
Report Date: 04/20/2023
Date Signed: 04/20/2023 02:45:03 PM


Document Has Been Signed on 04/20/2023 02:45 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:LAYLOR CARE HOME FOR THE ELDERLYFACILITY NUMBER:
075601572
ADMINISTRATOR:CLARKE, SHARONFACILITY TYPE:
740
ADDRESS:5168 JUDSONVILLE DRIVETELEPHONE:
(925) 775-4245
CITY:ANTIOCHSTATE: CAZIP CODE:
94531
CAPACITY:6CENSUS: 0DATE:
04/20/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
01:53 PM
MET WITH:Sharon Clarke, AdministratorTIME COMPLETED:
03:15 PM
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On 04/20/23 at 12PM, Licensing Program Analyst (LPA) D Panlilio arrived unannounced to conduct an annual required inspection. LPA met with administrator (ADM) and explained the purpose of the visit.

LPA toured the facility including but not limited to the front entrance, screening station, hand washing stations, kitchen, bathrooms, bedrooms and common areas.

Facility currently has no residents. ADM stated she will re-open the facility once she is ready. ADM stated she has kept her annual fees current and plan to re-open sometime next year.

Comfortable temperature is maintained at 74 deg F. Facility has a sufficient 2-day perishable and 7-day non-perishable food supply. Hot water temperature was measured at 118 deg F. Fire extinguishers were fully charged.



Smoke detectors and Carbon monoxide were operational. LPA observed sufficient lighting inside the facility. Facility has a mitigation plan in place dated 04/05/2021. The infection control leader is the administrator.

No deficiencies cited during visit. Exit interview conducted and a copy of this report provided.
SUPERVISOR'S NAME: Bennett FongTELEPHONE: (510) 622-2621
LICENSING EVALUATOR NAME: Daisy PanlilioTELEPHONE: (510) 286-4201
LICENSING EVALUATOR SIGNATURE:
DATE: 04/20/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/20/2023
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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