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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 079200825
Report Date: 01/23/2021
Date Signed: 01/23/2021 04:58:43 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:BLUEMEADOW CAREFACILITY NUMBER:
079200825
ADMINISTRATOR:HUANG, YANLINFACILITY TYPE:
740
ADDRESS:3262 MONTEVIDEO DRTELEPHONE:
(925) 833-2677
CITY:SAN RAMONSTATE: CAZIP CODE:
94583
CAPACITY:6CENSUS: 5DATE:
01/23/2021
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
03:50 PM
MET WITH:Yanlin "Cynthia" HuangTIME COMPLETED:
05:00 PM
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On 1/23/2021 at 3:50 PM, Licensing Program Analyst (LPA) L. Francisco conducted a health and safety inspection televisit concurrently with an initial 10-day complaint investigation via Facetime due to shelter-in-place directed by the Governor. LPA met with Administrator Yanlin "Cynthia" Huang.

During the health and safety inspection video call, LPA toured facility including but limited to bedrooms, common areas, kitchen, outdoor area, and bathrooms. LPA was unable to check hot water temperature setting, however, LPA advised Administrator to maintain hot water temperature between 105 and 120 degrees Fahrenheit. LPA observed one week supply of non-perishable and two day perishable food. LPA observed fire extinguisher is fully charged. Smoke detectors and carbon monoxide were observed throughout the facility.

No deficiencies cited during visit. Exit interview conducted and a copy of this report will be provided via email.
SUPERVISOR'S NAME: Harpreet HumpalTELEPHONE: (510) 285-3928
LICENSING EVALUATOR NAME: Lizette FranciscoTELEPHONE: (510) 286-4201
LICENSING EVALUATOR SIGNATURE:

DATE: 01/23/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/23/2021
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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