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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 079200127
Report Date: 02/22/2024
Date Signed: 02/22/2024 02:16:08 PM

Document Has Been Signed on 02/22/2024 02:16 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:LAMORINDA ADULT RESPITE CENTERFACILITY NUMBER:
079200127
ADMINISTRATOR:KATHLEEN JANUSZEWAKIFACILITY TYPE:
775
ADDRESS:433 MORAGA WAYTELEPHONE:
(925) 254-3465
CITY:ORINDASTATE: CAZIP CODE:
94563
CAPACITY: 35CENSUS: 8DATE:
02/22/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:30 AM
MET WITH:Kathleen Januszewski, Program DirectorTIME COMPLETED:
02:20 PM
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On 2/22/23 at 11:00 a.m., Licensing Program Analyst (LPA) Greg Clark arrived to conduct 1-Year Annual Required inspection. LPA met with Kathleen Januszewski, Program Director and explained the purpose of the visit. Day program operates from 11:00 a.m. to 3:00 p.m. Monday to Thursday. There were 3 staff observed working at the program today.

LPA toured facility including but not limited to: activity rooms, kitchen, bathrooms, office space, and the outside recreational area. Clients bring their own lunches and snacks are provided by the program. Emergency supplies, including water were observed. The hot water temperature in the hallway bathroom measured 114.2 degrees Fahrenheit. Cleaning supplies are locked and inaccessible to clients. Medications are not handled/dispensed by this program. There are no bodies of water or fire safety hazards observed. Restrooms are maintained in safe and in sanitary operating condition. Incontinent clients are kept clean and dry, and the facility is free of odors.

LPA reviewed 4 client and 4 staff files and all were complete. Emergency disaster drills are conducted every six months. Fire extinguishers throughout facility were operational. First aid kit was checked and observed to be complete.

Updated copies of the following documents were requested for facility file and are to be submitted to CCL by 2/29/24: LIC 610D Emergency Disaster Plan and the facility's Infection Control Plan.

No deficiencies were cited during this inspection. Exit interview conducted and a copy of this report provided.
SUPERVISORS NAME: Yvonne Flores-Larios
LICENSING EVALUATOR NAME: Gregory Clark
LICENSING EVALUATOR SIGNATURE: DATE: 02/22/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/22/2024
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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