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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 079200875
Report Date: 11/08/2021
Date Signed: 11/09/2021 09:29:01 AM

Document Has Been Signed on 11/09/2021 09:29 AM - 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,
, CA
FACILITY NAME:PARKER HOME AND ASSOCIATESFACILITY NUMBER:
079200875
ADMINISTRATOR:PARKER, JACQUELINEFACILITY TYPE:
735
ADDRESS:8 CASTLEWOOD DRIVETELEPHONE:
(925) 439-7533
CITY:PITTSBURGSTATE: CAZIP CODE:
94565
CAPACITY: 6CENSUS: 4DATE:
11/08/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:45 AM
MET WITH:Jaqueline Parker, AdministratorTIME COMPLETED:
11:22 AM
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Licensing Program Analyst (LPA) Araceli Canela arrived unannounced to conduct a Required - 1 Year inspection at approximately 9:45 AM, and met with Administrator, Jaqueline Parker. The annual inspection is focused on the Infection Control procedures and practices of this Adult Residential Facility.

LPA toured facility and grounds with Administrator and observed COVID-19 precaution signs posted in common areas to promote hand washing and physical distancing. LPA was screened for COVID-19 symptoms upon entrance to this facility. Visitors are said to be screened for COVID-19 symptoms (including temperature check) upon arrival to the facility. Infection control practices are present: entry procedures, face coverings, daily monitoring and temperatures checked for clients and staff, and 30-day PPE supply. Staff clean and disinfect the facility twice daily. Administrator stated high touched surface areas are disinfected after each use, such as the bathroom and kitchen area. Resident/Client rooms and common areas have tissue and hand sanitizer. Bathrooms are equipped with liquid soap, paper towels and garbage cans with touch less lids. Facility submitted a mitigation program plan, and plan has been reviewed 1/12/2021. Caregivers have completed PPE training but have not been N-95 Fit tested. Staff will follow indoor visitation requirement of verifying and tracking COVID-19 vaccination or verify non-essential visitors have proof of a negative COVID-19 test within 72 hours.
In addition, facility was found to be clean and at a comfortable temperature with all exits free from obstruction. No accessible bodies of water or fire safety hazards observed. Fire Extinguisher was found to be charged and purchased on 9/15/2021. Smoke and Carbon monoxide detectors were fully operational. There was sufficient supply of both perishable and nonperishable foods as required by Title 22 Regulations.

Exit interview and report read to Administrator. Due to printer malfunction, this report will be emailed to facility. No deficiencies cited during this inspection
SUPERVISORS NAME: Kimberley Mota
LICENSING EVALUATOR NAME: Araceli Canela
LICENSING EVALUATOR SIGNATURE: DATE: 11/08/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/08/2021
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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