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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 079200055
Report Date: 04/16/2024
Date Signed: 04/16/2024 01:09:39 PM

Document Has Been Signed on 04/16/2024 01:09 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:SUMMERFIELD HOMES #1FACILITY NUMBER:
079200055
ADMINISTRATOR/
DIRECTOR:		MARGARITA D PAGDANGANANFACILITY TYPE:
735
ADDRESS:5313 SUMMERFIELD DRIVETELEPHONE:
(925) 706-9990
CITY:ANTIOCHSTATE: CAZIP CODE:
94531
CAPACITY: 6CENSUS: 6DATE:
04/16/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
11:00 AM
MET WITH:Margarita Pagdanganan, AdministratorTIME VISIT/
INSPECTION COMPLETED:
01:17 PM
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On 04/16/24 at 11AM, Licensing Program Analysts (LPAs) D Panlilio conducted an unannounced required annual inspection and met with administrator (ADM). LPA explained the purpose of the visit with ADM. LPA observed no clients at the facility during visit. ADM stated they were all attending their individual day programs. ADM stated this is a level 3 facility with the Regional Center of the East Bay (RCEB).

LPA toured the facility inside out with ADM. LPA inspected the living room, kitchen, dining area, bedrooms, bathroom, laundry room, side, and backyards. Food supplies were observed sufficient good for seven (7) days of non-perishables and two (2) days of perishables, and protected from contamination. Facility has working carbon monoxide and smoke alarm detectors. Fire extinguisher checked, observed fully charged, and tag showed serviced on 08/11/23. Hot water temperature in the bathroom was tested and measured at 111 deg F. First aid kit inspected and observed complete with manual. Facility staff conducts fire and earthquake drills with clients every other month. All indoor and outdoor passageways were free of obstructions. Adequate supplies of PPE were also observed stored in the garage. Facility follows daily cleaning, sanitation of frequently touched common surfaces using Clorox and Lysol disinfectants. Infection control leader is the ADM. LPA reviewed 3 staff and 5 client files during visit.

Updated copies of the following documents were obtained from ADM:
 LIC500- Personnel Report, Client Roster
 LIC308- Designation of Facility Responsibility
 LIC610D- Emergency/Disaster Plan/Infection Control Plans
 Evidence of Surety Bond

No deficiencies cited during this visit. Exit interview conducted and a copy of this report provided.
SUPERVISORS NAME: Bennett Fong
LICENSING EVALUATOR NAME: Daisy Panlilio
LICENSING EVALUATOR SIGNATURE: DATE: 04/16/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/16/2024
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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