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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 079200382
Report Date: 07/19/2024
Date Signed: 07/19/2024 12:00:25 PM


Document Has Been Signed on 07/19/2024 12:00 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
OAKLAND ASC, 1515 CLAY STREET, STE. 310
OAKLAND, CA 94612



FACILITY NAME:BROOKDALE DIABLO LODGEFACILITY NUMBER:
079200382
ADMINISTRATOR:GRADY, WILLIAMFACILITY TYPE:
740
ADDRESS:950 DIABLO ROADTELEPHONE:
(925) 838-8300
CITY:DANVILLESTATE: CAZIP CODE:
94526
CAPACITY:128CENSUS: 102DATE:
07/19/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Executive Director, Rachael DavisTIME COMPLETED:
12:10 PM
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On 07/19/2024 at 9:20 AM, Licensing Program Analyst (LPA) A. Gomez arrived unannounced to conduct 1-Year Annual Required inspection. LPA met with Executive Director, Rachael Davis and explained the purpose of the visit. The facility's fire clearance was approved for all may be non-ambulatory of which 8 may be bedridden.

LPA toured the facility with Executive Director including but not limited to 6 residents apartments, bathrooms, activity room, kitchen, common area and courtyard. There are no bodies of water observed. LPA observe lighting in all rooms are adequate for the comfort and safety of the residents. Hallway temperature was maintained at 74 degrees F. The hot water temperature in a sample of residents’ shared bathroom were measured at 112.6, 109.2, 108.9 degrees Fahrenheit. Residents’ bathrooms are equipped with grab bars and non-skid mats. There is a minimum of one week supply of nonperishable and 2-day of perishable foods. Centrally stored medications, sharps and toxic are locked and inaccessible to residents in care. The freezer temperature measured at 0 degrees F and the refrigerator 36 degrees F.

Fire extinguisher was last serviced on 2/06/2024. Disaster Drill was last conducted 7/18/2024. Emergency Disaster plan last reviewed 10/19/2023. Smoke detectors and sprinklers are interconnected and observed throughout facility.

LPA reviewed 6 staff records and 6 of 6 are associated and have current first-aid training. LPA reviewed 5 residents records.


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: 07/19/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/19/2024
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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