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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 079200301
Report Date: 07/23/2024
Date Signed: 07/23/2024 12:26:56 PM

Document Has Been Signed on 07/23/2024 12:26 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:HARMONY'S ADULT RESIDENTIAL FACILITYFACILITY NUMBER:
079200301
ADMINISTRATOR/
DIRECTOR:		MARIA CUMISKEYFACILITY TYPE:
735
ADDRESS:372 OCEANA DRIVETELEPHONE:
(925) 432-3974
CITY:PITTSBURGSTATE: CAZIP CODE:
94565
CAPACITY: 6CENSUS: 6DATE:
07/23/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:45 AM
MET WITH:Maria Ramirez, Direct Support ProfessionalTIME VISIT/
INSPECTION COMPLETED:
12:30 PM
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On 7/23/2024 at 10:00am, Licensing Program Analyst (LPA) L. Hall conducted an unannounced 1-year required inspection. LPA met with Maria Ramirez, Direct Support Professional, and explained the purpose of the visit. Administrator, Maria Cumiskey, arrived at 11:15am. The administrator currently holds a certificate (#7006512735) that expires on 02/8/2026. Facility has a fire clearance for two (2) ambulatory and four (4) non-ambulatory.

LPA toured the facility including but not limited to bedrooms, bathrooms, kitchen, common area, garage, and back yard. The facility consists of five (5) bedrooms and two (2) bathrooms. All indoor passageways are kept free of obstruction. There were no bodies of water observed. A comfortable temperature for clients is maintained at 72 degrees Fahrenheit. LPA 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 105.6 degrees Fahrenheit. All toilets, hand washing, and baths are safe, sanitary and in operating condition. Hand washing poster, paper towel, and soap observed at all hand washing stations. The supply of extra hygiene was available for residents. There is a minimum of 7-day non-perishables and 2-day perishables foods.

Continued on LIC809C.
SUPERVISORS NAME: Harpreet Humpal
LICENSING EVALUATOR NAME: Laura Hall
LICENSING EVALUATOR SIGNATURE: DATE: 07/23/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/23/2024
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1515 CLAY STREET, STE. 310
OAKLAND, CA 94612
FACILITY NAME: HARMONY'S ADULT RESIDENTIAL FACILITY
FACILITY NUMBER: 079200301
VISIT DATE: 07/23/2024
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Continued from LIC809.

Smoke detectors/carbon monoxide were in operating condition during visit. Emergency disaster plan updated 3/1/2024. Fire extinguisher was last services on 7/21/2023. Fire drill last conducted 5/1/2024. First aid kit was observed to be complete.

Four (4) staff records were reviewed, current and complete. All six (6) clients' records reviewed, current, and complete. LPA reviewed P&I.

The following forms to be updated and submitted to CCLD by 7/30/2024:
  • Surety Bond
  • LIC500 (Personnel Record)
  • LIC308 (Designation of facility Responsibility)
  • LIC 400 Affidavit Regarding Client/Resident Cash Resources


No deficiencies cited during visit.

Exit interview conducted and a copy of this report provided.
SUPERVISORS NAME: Harpreet Humpal
LICENSING EVALUATOR NAME: Laura Hall
LICENSING EVALUATOR SIGNATURE:

DATE: 07/23/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/23/2024
LIC809 (FAS) - (06/04)
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