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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 079200787
Report Date: 11/04/2020
Date Signed: 11/05/2020 08:34:01 AM

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:DIANA'S CARE HOMEFACILITY NUMBER:
079200787
ADMINISTRATOR:REANO-AQUINO, GRACEFACILITY TYPE:
740
ADDRESS:27402 MANON AVETELEPHONE:
(510) 786-9982
CITY:HAYWARDSTATE: CAZIP CODE:
94544
CAPACITY:35CENSUS: 32DATE:
11/04/2020
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Grace AquinoTIME COMPLETED:
11:00 AM
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Licensing Program Analyst (LPA) Luisa Fontanilla conducted a pre licensing continuation televisit and met with Administrator Grace Aquino. LPA explained that this televisit is being conducted via Facetime in connection with the shelter in place order of the governor and telework directive by the management.

LPA with Aquino inspected Room 16, Room 19 and bath/shower rooms as indicated in the Technical Assistance issued during the initial pre licensing inspection on 10/1/2020. Based on the initial pre licensing inspection, there were only 2 shower rooms available for use of 32 residents. Today, LPA was informed that a total of 5 common shower rooms available for use of residents. In regards to Room 16, LPA observed there was no dresser. Administrator states that they will provide a dresser in the room and will let LPA know. In regards to Room 19, LPA observed that facility has not implemented any action to correct the issue of providing future residents of Room 19 direct access to the facility. Future residents will have to enter/exit the building using Exit 2 to get to Room 19.

Administrator was advised by LPA to notify CCL when facility has implemented corrections.

LPA will notify CAB on the status of this pre licensing inspection.

A copy of this report will be forwarded to Administrator via email.
SUPERVISOR'S NAME: Harpreet HumpalTELEPHONE: (510) 285-3928
LICENSING EVALUATOR NAME: Luisa FontanillaTELEPHONE: (510) 286-7147
LICENSING EVALUATOR SIGNATURE:

DATE: 11/04/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/04/2020
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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