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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 02:27:04 PM

Document Has Been Signed on 08/31/2022 02:27 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:Case Management - OtherUNANNOUNCEDTIME BEGAN:
01:50 PM
MET WITH:Rebecca Hernandez, AdministratorTIME COMPLETED:
02:35 PM
NARRATIVE
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On 8/31/2022 at 1:50PM Licensing Program Analyst (LPA) L. Hall arrived unannounced to conduct a Case Management visit. LPA met with Rebecca Hernandez, Administrator and explained the purpose of the visit.

While LPA L. Hall was conducting an annual inspection on 8/31/2022, during facility tour LPA observed a accessory dwelling unit (ADU) in the back yard. Administrator stated ADU is for personal use and the clients will not have any access to the property. LPA reviewed records but did not observe any documents received prior to making the alterations. During the visit LPA collected an LIC200, building permit, construction company information and a copy of the certificate of liability insurance. LPA will order a fire clearance.

The deficiency was observed (see LIC809D) and cited from the California Code of Regulation, Title 22. Failure to correct the deficiency may result in civil penalties.

Exit interview conducted. A copy of this report and appeal rights 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
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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Document Has Been Signed on 08/31/2022 02:27 PM - It Cannot Be Edited


Created By: Laura Hall On 08/31/2022 at 02:07 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

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

FACILITY NAME: WESTWOOD RESIDENTIAL CARE
FACILITY NUMBER: 079200050

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/31/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
09/07/2022
Section Cited
CCR
80086(a)

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80086 Alterations to Existing Building or New Facilities
(a) Prior to construction or alterations, all licensees shall notify the licensing agency of the proposed change. This requirement was not met as evidence by:
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Administrator agreed to submit an updated facility sketch and LIC200 to CCLD by POC date.
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Based on LPAs observation and record review Licensee did not comply with the section cited above in notifying CCLD about the alterations prior construction, which poses a potential health and safety risk to persons in care.
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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 Humpal
LICENSING EVALUATOR NAME:Laura Hall
LICENSING EVALUATOR SIGNATURE:
DATE: 08/31/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/31/2022


LIC809 (FAS) - (06/04)
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