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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 079200816
Report Date: 11/04/2021
Date Signed: 11/04/2021 07:15:17 PM

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:SACRED HANDS LIVING IIFACILITY NUMBER:
079200816
ADMINISTRATOR:PANESAR, RAJWANT KFACILITY TYPE:
740
ADDRESS:3760 PINTAIL DRTELEPHONE:
(209) 762-2910
CITY:ANTIOCHSTATE: CAZIP CODE:
94509
CAPACITY:6CENSUS: 4DATE:
11/04/2021
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
06:46 PM
MET WITH:Rajwant Panesar, AdministratorTIME COMPLETED:
07:30 PM
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On 11/04/21 at 6:46PM, while at the facility for another reason, Licensing Program Analyst (LPA) Daisy Panlilio discussed with administrator (ADM) COVID-19 infection control mitigation procedures.

ADM stated that witness (W1) would visit resident (R2) every day by using a side entrance leading to her bedroom. LPA advised ADM that per PIN 20-38-ASC, best practices for indoor visitation include facility to designate one area to enter the facility and a different area to exit the facility. ADM agreed to comply with this COVID-19 requirement during visit.
SUPERVISOR'S NAME: Bennett FongTELEPHONE: (510) 622-2621
LICENSING EVALUATOR NAME: Daisy PanlilioTELEPHONE: (510) 286-4201
LICENSING EVALUATOR SIGNATURE:

DATE: 11/04/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/04/2021
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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