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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 079200396
Report Date: 08/31/2022
Date Signed: 09/02/2022 08:59:17 AM

Document Has Been Signed on 09/02/2022 08:59 AM - 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:HAND IN HAND FOR PROGRESS DAY PROGRAMFACILITY NUMBER:
079200396
ADMINISTRATOR:JIAN FRANCO GAMEZFACILITY TYPE:
775
ADDRESS:2025 PT. CHICAGO HWY.TELEPHONE:
(925) 332-7973
CITY:CONCORDSTATE: CAZIP CODE:
94520
CAPACITY: 30CENSUS: 14DATE:
08/31/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Kathleen Womack, Case ManagerTIME COMPLETED:
11:45 AM
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On 08/31/2022 at 10:00 AM, Licensing Program Analysts (LPAs) C. Fowler and L. Alexander arrived unannounced to conduct 1-Year Infection Control inspection. LPAs met with Case Manager, Kathleen Womack and explained the purpose of the visit. Day program operates from 7:30AM - 3:30PM. There were 11 staff observed working with the 14 clients here today.

LPAs toured facility with Case Manager including but not limited to, multiple activity rooms, kitchen, bathrooms, office space, and the outside recreational area. Clients bring their own lunches and snacks. Emergency supplies, including water were observed. Cleaning supplies are locked and inaccessible to clients. Medications are handled/dispensed by this program which are locked in a locked cabinet. 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. First aid kit was checked.

The following forms to be updated and submitted to CCL by 09/07/2022:

LIC 308 Designation of Administrative Responsibility
LIC 309 Administrative Organization
LIC 610 Emergency Disaster Plan

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: 08/31/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/31/2022
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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