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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 079200220
Report Date: 11/01/2023
Date Signed: 11/01/2023 03:57:12 PM

Document Has Been Signed on 11/01/2023 03:57 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:GARDEN BRENTWOODFACILITY NUMBER:
079200220
ADMINISTRATOR:JACKIE BAILEYFACILITY TYPE:
775
ADDRESS:1191 CENTRAL BLVD., STE. BTELEPHONE:
(925) 626-3642
CITY:BRENTWOODSTATE: CAZIP CODE:
94513
CAPACITY: 30CENSUS: 10DATE:
11/01/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
01:50 PM
MET WITH:Annette Winn-Rankin, Program SupervisorTIME COMPLETED:
04:00 PM
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On 11/01/23 at 1:50 p.m., Licensing Program Analyst (LPA) Greg Clark arrived unannounced to conduct 1-Year Annual Required inspection. LPA met with Annette Winn-Rankin, Program Supervisor and explained the purpose of the visit.

LPA toured facility including but not limited to, activity rooms, kitchen, bathrooms, office space, and the changing rooms. Clients bring their own lunches and several are feed via g-tube. Emergency supplies, including water were observed. The hot water temperature in the shared bathroom measured 117.8 degrees Fahrenheit. Cleaning supplies are locked and inaccessible to clients. Medications are locked and inaccessible to clients. There are no bodies of water or fire safety hazards observed. Restrooms are maintained in safe and in sanitary operating condition, and additional equipment for the physically handicapped was observed. Incontinent clients are kept clean and dry, and the facility is free of odors. The program has 1 van used for client outings and transportation. LPA reviewed 5 client and 5 staff files; all were complete. Disaster drills are conducted as required. Fire extinguishers throughout facility were last inspected 6/22/23. 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 11/08/23: LIC 610E Emergency Disaster 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: 11/01/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/01/2023
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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