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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 079200579
Report Date: 09/14/2023
Date Signed: 09/14/2023 02:19:23 PM

Document Has Been Signed on 09/14/2023 02:19 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:P & P DEVELOPMENTAL SERVICESFACILITY NUMBER:
079200579
ADMINISTRATOR:TING, VICKY SFACILITY TYPE:
775
ADDRESS:4851-C LONE TREE WAYTELEPHONE:
(925) 813-1979
CITY:ANTIOCHSTATE: CAZIP CODE:
94531
CAPACITY: 40CENSUS: 31DATE:
09/14/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
11:00 AM
MET WITH:Priscilla Calica, Administrator
Olive Tapdasan, Manager on Duty		TIME COMPLETED:
02:40 PM
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Licensing Program Analyst (LPA) D Panlilio arrived unannounced to conduct an annual required Inspection. LPA explained the purpose of the visit with staff (ADM, MOD).
LPA inspected the facility including, but not limited to, bathroom, kitchen, stimulation room, two (2) changing rooms, theater room, arts and crafts room, activity room, office space and conference space. LPA observed a screening station at the front entrance for staff, clients and visitors. The facility has two (2) bathrooms. Hot water temperature in a client's bathroom measured at 117 degrees, F. The facility temperature maintained at 74 degrees F. Facility maintains a 1:3 staff to client ratio. Clients supply their own lunch and snacks. Drinking water is available for staff and clients. The facility administers medications to clients at day program. Program provides training regarding independent living skills and social skills. Community outings, activities and exercise sessions are also provided. Toxins, medications and sharps observed stored locked. Staff does not handle client's cash resources. Facility has four vans to transport clients. Van maintenance conducted on a regular basis. Administrator is the infection control leader. Fire extinguisher was observed fully charged and last inspected on 01/23/23. First aid kit, smoke detectors and carbon monoxide were observed operational. Emergency Disaster Plan, Complaint poster, Personal rights, Cough/sneeze etiquette, proper hand-washing signs were observed posted in common areas. Exits/passageways were observed free of obstruction. Staff present has fingerprint clearances and associated to the facility. Earthquake & Fire drills conducted every 4 months. LPA reviewed 5 client & staff files. LPA interviewed 2 staff and 2 clients during visit. There were no deficiencies observed/cited during inspection today.

LPA obtained the following documents from administrator:
  • Client Roster
  • LIC 308 Designation of Administrative Responsibility
  • LIC 500 Personnel Report
  • LIC 610D Emergency Disaster Plan
SUPERVISORS NAME: Bennett Fong
LICENSING EVALUATOR NAME: Daisy Panlilio
LICENSING EVALUATOR SIGNATURE: DATE: 09/14/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/14/2023
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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