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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 079200280
Report Date: 02/02/2023
Date Signed: 02/02/2023 03:57:52 PM

Document Has Been Signed on 02/02/2023 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:DANERRY HOMEFACILITY NUMBER:
079200280
ADMINISTRATOR:LANGIT, DARLENEFACILITY TYPE:
735
ADDRESS:1028 SANDPOINT DRIVETELEPHONE:
(510) 734-1984
CITY:RODEOSTATE: CAZIP CODE:
94572
CAPACITY: 6CENSUS: 6DATE:
02/02/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
02:40 PM
MET WITH:Amelia Concepcion, CaregiverTIME COMPLETED:
04:20 PM
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On 2/2/2023 at 2:40PM, Licensing Program Analyst (LPA) C. Fowler arrived unannounced to conduct an Infection Control Inspection. LPA met with Darlene Langit, Administrator and explained the purpose of the visit.

Upon entry, LPA's temperature was checked. LPA observed screening station and COVID-19 signs were posted above screening station. LPA toured facility including but not limited to common areas, bathrooms, bedrooms, back yard, and kitchen. LPA observed cough etiquette and physical distancing posted in the common areas. All hand washing stations were equipped with soap and paper towel. Hand washing posters were posted at hand washing stations. Hot water temperature in the shared clients’ bathroom was measured at 119.5 degrees Fahrenheit. Fire extinguisher last serviced on 11/22/2022.

During record review, LPA observed visitors sign-in log. LPA observed facility has a copy of the mitigation plan on file.

LPA request the following documents to be submitted to CCLD by 12/15/2022.
  • LIC610D Emergency Disaster Plan
  • LIC500 Personnel Report
  • LIC9282 Infection Control Plan / MPOX Plan
  • LIC308 Designation of Administrative Responsibility
  • An updated copy of Administrator certificate

No deficiencies cited during visit. Exit interview conducted and a copy of this report provided.
SUPERVISORS NAME: Bennett Fong
LICENSING EVALUATOR NAME: Carol Fowler
LICENSING EVALUATOR SIGNATURE: DATE: 02/02/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/02/2023
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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