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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 079200877
Report Date: 11/07/2022
Date Signed: 11/08/2022 11:48:59 AM

Document Has Been Signed on 11/08/2022 11:48 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, 1515 CLAY STREET, STE. 310
OAKLAND, CA 94612
FACILITY NAME:NATIONAL PSYCHIATRIC CARE AND REHAB SERVICES INCFACILITY NUMBER:
079200877
ADMINISTRATOR:CANDYCE PIRTLE-SMALLFACILITY TYPE:
772
ADDRESS:2181 TICE VALLEY BLVDTELEPHONE:
(925) 478-3795
CITY:WALNUT CREEKSTATE: CAZIP CODE:
94595
CAPACITY: 12CENSUS: 10DATE:
11/07/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
12:15 PM
MET WITH:Candyce Pirtle-SmallsTIME COMPLETED:
02:15 PM
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On 11/07/2022, Licensing Program Analyst (LPA) J. Sampair conducted an infection control annual inspection. LPA explained the purpose of the visit with Administrator Candyce Pirtle-Smalls. Facility toured inside and out.

Facility has an infection control plan in place that they are following. The designated infection control leader is the administrator. They have one central entry point that has been designated for universal entry screening with the station located near the front entrance with an electronic visitor's log, hand sanitizer, face masks, and no touch thermometer. Facility follows daily cleaning, sanitation of frequently touched common surfaces with disinfectants. COVID-19 signs were posted to promote hand washing, cough/sneeze etiquette and physical distancing.

No obstructions inside or outside. Room and hot water temperatures were in the acceptable range, the carbon monoxide and smoke alarms were checked on a monthly basis. Fire extinguishers had been recharged within 12 months. They had sufficient food, emergency supplies, and PPE.

An administrator is on site more than the required 20 hour minimum each week to oversee business operations.

No citations were issued.

Exit interview conducted, copy of Appeal Rights, and a copy of this report provided via email.
SUPERVISORS NAME: Harpreet Humpal
LICENSING EVALUATOR NAME: James Sampair
LICENSING EVALUATOR SIGNATURE: DATE: 11/07/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/07/2022
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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