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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 079200603
Report Date: 08/13/2024
Date Signed: 08/19/2024 08:21:26 AM

Document Has Been Signed on 08/19/2024 08:21 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
OAKLAND ASC, 1515 CLAY STREET, STE. 310
OAKLAND, CA 94612
FACILITY NAME:OUR HOMEFACILITY NUMBER:
079200603
ADMINISTRATOR/
DIRECTOR:		DUGAN, BERNADETTEFACILITY TYPE:
735
ADDRESS:370 VERNAL DRIVETELEPHONE:
(925) 933-8706
CITY:ALAMOSTATE: CAZIP CODE:
94507
CAPACITY: 6CENSUS: 2DATE:
08/13/2024
TYPE OF VISIT:Case Management - Health ChecksUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
12:00 PM
MET WITH:Licensee/Administrator, Bernadette DuganTIME VISIT/
INSPECTION COMPLETED:
01:40 PM
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On 8/13/2024 at 12:00PM Licensing Program Analyst (LPA) A. Gomez arrived unannounced to conduct a health and safety check as a result of a recent complaint investigation (15-AS-20240708085122). LPA met with Licensee/Administrator Bernadette Dugan and explained the purpose of the visit. No clients were present during the visit.

LPA toured facility including but not limited to the bedrooms, bathrooms, common area, kitchen, and outdoor area. Hot water temperature was measured at 108.6 degrees F in the hallway bathroom. There was not a 7-day of non-perishable and 2-day of perishable food supplies. LPA advised administrator to purchase more food today. LPA will not cite because facility was already cited "80076(a)(1)" recently and is within their POC time frame. Administrator states that they go grocery shopping at least once a week. Refrigerator temperature was observed at 38 degrees F. There are no medications at the facility currently. LPA observed a two in one NEST smoke detector and carbon monoxide detector. First-aid kit was complete. Fire extinguisher was observed to be full and last serviced on 8/22/2023. There are no accessible bodies of water observed. Indoor and outdoor passageways are free of obstruction.

No deficiencies cited during visit. Exit interview conducted and a copy of this report provided.
SUPERVISORS NAME: Yvonne Flores-Larios
LICENSING EVALUATOR NAME: Alona Gomez
LICENSING EVALUATOR SIGNATURE: DATE: 08/13/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/13/2024
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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