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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 079200110
Report Date: 04/23/2024
Date Signed: 04/23/2024 09:03:36 AM


Document Has Been Signed on 04/23/2024 09:03 AM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

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



FACILITY NAME:AVANCARE ADULT RESIDENTIAL FACILITYFACILITY NUMBER:
079200110
ADMINISTRATOR:CESAR REDOLOSO IIIFACILITY TYPE:
735
ADDRESS:2100 CRISTINA WAYTELEPHONE:
(925) 308-7586
CITY:BRENTWOODSTATE: CAZIP CODE:
94513
CAPACITY:6CENSUS: 6DATE:
04/23/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
07:30 AM
MET WITH:Caregiver, Jaime MendozaTIME COMPLETED:
09:15 AM
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On 04/23/2024 at 7:30 AM, Licensing Program Analyst (LPA) A. Gomez arrived unannounced to conduct Required 1 Year Annual inspection. LPA met with Caregiver, Jaime Mendoza and explained the purpose of the visit. Administrator later arrived Cesar Redoloso III. The facility’s fire clearance was approved for 6 Ambulatory.

LPA toured the facility with Jaime Mendoza including but not limited to bedrooms, bathrooms, kitchen, common area and backyard. The facility consists of 5 total bedrooms which 4 bedrooms are occupied by the clients and 1 bedroom is occupied by staff. All outdoor and indoor passageways are kept free of obstruction. There are no bodies of water. A comfortable temperature for clients is maintained at 70 degree Fahrenheit. LPAs observed lighting in all rooms are adequate for the comfort and safety of the clients. Hot water temperature in the shared clients’ bathroom was measured at 119.8 degrees Fahrenheit . All toilets, hand washing stations, and bathing stations are safe, sanitary and in operating condition. The supply of extra hygiene’s were available for clients. There is a minimum of 7 day supply of non-perishables and 2 day perishables food supply.

Smoke detectors and carbon monoxide were in operating condition during visit. Emergency disaster plan up to date. Fire extinguisher was last serviced on 10/23/2023. First aid kit was observed to be complete. Fire drill was last conducted on 2/3/2024.

At 7:45 AM, LPA reviewed 5 residents records. At 8:15 AM, LPA reviewed 5 of 10 staff records and 5 of 5 have current first aid training and associated to the facility. At 8:30 AM, LPA reviewed a sample of 6 of 6 resident’s medications.

No deficiencies cited during visit. Exit interview conducted and a copy of this report provided.
SUPERVISOR'S NAME: Yvonne Flores-LariosTELEPHONE: (510) -28-0517
LICENSING EVALUATOR NAME: Alona GomezTELEPHONE: 510-239-1306
LICENSING EVALUATOR SIGNATURE:
DATE: 04/23/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/23/2024
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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