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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 079200787
Report Date: 08/23/2023
Date Signed: 08/23/2023 04:00:59 PM


Document Has Been Signed on 08/23/2023 04:00 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:DIANA'S CARE HOMEFACILITY NUMBER:
079200787
ADMINISTRATOR:REANO-AQUINO, GRACEFACILITY TYPE:
740
ADDRESS:27402 MANON AVENUETELEPHONE:
(510) 786-9982
CITY:HAYWARDSTATE: CAZIP CODE:
94544
CAPACITY:35CENSUS: 35DATE:
08/23/2023
TYPE OF VISIT:Case Management - Health ChecksUNANNOUNCEDTIME BEGAN:
02:15 PM
MET WITH:Grace Aquino/Administrator TIME COMPLETED:
04:00 PM
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On this day, August 23, 2023, Licensing Program Analyst (LPA) Delmundo arrived unannounced to conduct a health and safety inspection as a result of the Department receiving a Priority 1 complaint (Complaint # 15-AS-20230818151513). LPA met with Grace Aquino, administrator, and informed the reason for visit.

LPA toured the facility inside and out including but not limited to living room, kitchen, dining room, shower and bathrooms, side and bakyard. LPA randomly selected 8 residents rooms for inspection. Food supplies were observed sufficient for 2 days of perishable and 7 days of non-perishable. Hot water in one of the common bathrooms was tested and measured at 110.8 degrees Fahrenheit. Hallways and yards were observed free of obstructions. Laundry room was observed locked.

Thirty four (34) residents were present during inspection, 17 of which were in the dining room playing bingo, 5 watching tv in the living room and the rest were in their rooms. One of the resident was out in the day program.

No deficiency observed on this day.

Exit interview conducted, and copy of this report provided.



SUPERVISOR'S NAME: Bennett FongTELEPHONE: (510) 622-2621
LICENSING EVALUATOR NAME: Alicia DelmundoTELEPHONE: (510) 286-4201
LICENSING EVALUATOR SIGNATURE:
DATE: 08/23/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/23/2023
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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