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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 079200827
Report Date: 05/05/2021
Date Signed: 05/05/2021 04:33:43 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:LOVING HANDS CARE HOME LLCFACILITY NUMBER:
079200827
ADMINISTRATOR:SAN DIEGO-TOMAS, CECILIAFACILITY TYPE:
740
ADDRESS:748 VAQUEROS AVETELEPHONE:
(510) 245-3738
CITY:RODEOSTATE: CAZIP CODE:
94572
CAPACITY:6CENSUS: 3DATE:
05/05/2021
TYPE OF VISIT:Case Management - OtherANNOUNCEDTIME BEGAN:
03:30 PM
MET WITH:Cecilia San Diego-Tomas, AdministratorTIME COMPLETED:
04:20 PM
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On 05/05/2021 at 3:30pm, Licensing Program Analyst (LPA), L. Hall conducted an announced health and safety check via FaceTime as a result of the Department receiving a priority 2 complaint. LPA met with Cecilia San Diego-Tomas, Administrator and explained that due to the shelter-in-place order by the Governor, check was being done over the phone.

During the health and safety check LPA observed 1 resident sitting at kitchen table eating a snack with caregiver, and 2 residents sitting in the living room. LPA toured the facility with administrator, including but not limited to bedrooms, kitchen, bathroom, and common areas. There was an minimum of 7-day non-perishables and 2-day perishables foods. There was not a date for fire extinguishers expiration. Administrator did not know how to test the carbon monoxide alarm. Fire alarm is wired directly to fire department. Residents in care appear to be safe and there are no imminent health/safety concerns on today's date.

No deficiencies were observed during the health and safety check.

Exit interview conducted and a copy of this report provided by email.
SUPERVISOR'S NAME: Harpreet HumpalTELEPHONE: (510) 285-3928
LICENSING EVALUATOR NAME: Laura HallTELEPHONE: (510) 622-2024
LICENSING EVALUATOR SIGNATURE:

DATE: 05/05/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/05/2021
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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