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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 079200778
Report Date: 12/27/2023
Date Signed: 12/27/2023 11:51:36 AM

Document Has Been Signed on 12/27/2023 11:51 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
E BAY DELTA AC/SC, 1515 CLAY STREET, STE. 310
OAKLAND, CA 94612
FACILITY NAME:SOPHIA'S HOMEFACILITY NUMBER:
079200778
ADMINISTRATOR:HAYAG, LORNAFACILITY TYPE:
735
ADDRESS:5243 CONCORD BLVDTELEPHONE:
(925) 683-1818
CITY:CONCORDSTATE: CAZIP CODE:
94521
CAPACITY: 6CENSUS: 6DATE:
12/27/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Ernesto Golez, LicenseeTIME COMPLETED:
12:10 PM
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On 12/27/2023 at 9:30 AM, Licensing Program Analyst (LPA) P. Watson arrived unannounced to conduct Required 1 Year Annual inspection. LPA met with Licensee, Ernesto Golez and explained the purpose of the visit. The facility’s fire clearance was approved for 4 Ambulatory and 2 Non-Ambulatory.

LPA toured the facility including but not limited to bedrooms, bathrooms, kitchen, common area and backyard. The facility consists of 4 total bedrooms which 3 bedrooms are occupied by the clients and 1 bedroom is occupied by staff. All outdoor and indoor passageways are kept free of obstruction. A comfortable temperature for clients is maintained at 71 degree Fahrenheit. LPA observed lighting in all rooms are adequate for the comfort and safety of the clients. Hot water temperature in the shared clients’ bathrooms were measured at 111.6 degree Fahrenheit and 117.2 degree Fahrenheit. All toilets, hand washing stations, and bathing stations are safe, sanitary and in operating condition. LPA observed extra hygiene supplies in the hallway closet. There is a minimum of 7 day supply of non-perishables and 2 day perishables food supply.

Smoke detectors and carbon monoxide were in operating condition during visit. First aid kit was observed to be complete. Fire extinguisher was last serviced on 03/31/2023. Earthquake drill was last conducted on 08/27/2023. Fire drill was last conducted on 11/29/2023.

At 10:10 AM, LPA reviewed 6 of 6 client records. At 10:50 AM, LPA reviewed 5 staff records and 5 of 5 have current first aid training and associated to the facility. At 11:20 AM, LPA reviewed a sample of 1 of 6 client medications.


No deficiencies cited during visit. Exit interview conducted and a copy of this report provided.
SUPERVISORS NAME: Yvonne Flores-Larios
LICENSING EVALUATOR NAME: Paris Watson
LICENSING EVALUATOR SIGNATURE: DATE: 12/27/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/27/2023
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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