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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 079200050
Report Date: 08/31/2022
Date Signed: 08/31/2022 02:25:17 PM

Document Has Been Signed on 08/31/2022 02:25 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:WESTWOOD RESIDENTIAL CAREFACILITY NUMBER:
079200050
ADMINISTRATOR:REBECCA HERNANDEZFACILITY TYPE:
735
ADDRESS:2228 WESTWOOD COURTTELEPHONE:
(925) 709-1595
CITY:PITTSBURGSTATE: CAZIP CODE:
94565
CAPACITY: 6CENSUS: 5DATE:
08/31/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
12:45 PM
MET WITH:Rebecca Hernandez, AdministratorTIME COMPLETED:
01:50 PM
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On 8/31/2022 at 12:45PM, Licensing Program Analyst (LPA) L. Hall arrived unannounced to conduct an Infection Control Inspection. LPA Administrator Rebecca Hernandez and explained the purpose of the visit.

Upon entry, LPA's temperature was not checked. LPA observed screening station and COVID-19 signs were posted on the entrance. LPA toured facility including but not limited to common areas, bathrooms, bedrooms, backyard, kitchen, and garage. LPA observed cough etiquette and physical distancing posted in the common areas. All hand washing stations were equipped with soap and paper towel. Hand washing posters were posted at hand washing stations. Hot water temperature in the shared clients’ bathroom was measured at 129.7 degrees Fahrenheit. Fire extinguisher last serviced on 05/13/2022. There is a minimum of 7-day non-perishables and 2-day perishables foods.

During record review, LPA observed visitors log and temperature log for both residents and staff. LPA observed facility has a copy of Infection Control Plan on file. LPA observed food and paper supplies are sufficient.

Continued on LIC809C.
SUPERVISORS NAME: Harpreet Humpal
LICENSING EVALUATOR NAME: Laura Hall
LICENSING EVALUATOR SIGNATURE: DATE: 08/31/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/31/2022
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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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: WESTWOOD RESIDENTIAL CARE
FACILITY NUMBER: 079200050
VISIT DATE: 08/31/2022
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Continued from LIC809.

LPA request the following documents to be submitted to CCLD by 9/7/2022.

LIC 500 Personnel Report
LIC 308 Designation of Administrative Responsibility
LIC 610D Emergency Disaster Plan
Administrator Certificate

Exit interview conducted and a copy of this report provided.
SUPERVISORS NAME: Harpreet Humpal
LICENSING EVALUATOR NAME: Laura Hall
LICENSING EVALUATOR SIGNATURE:

DATE: 08/31/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/31/2022
LIC809 (FAS) - (06/04)
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