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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 079200877
Report Date: 10/14/2024
Date Signed: 10/14/2024 11:43:42 AM

Document Has Been Signed on 10/14/2024 11:43 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
OAKLAND ASC, 1515 CLAY STREET, STE. 310
OAKLAND, CA 94612
FACILITY NAME:NATIONAL PSYCHIATRIC CARE AND REHAB SERVICES INCFACILITY NUMBER:
079200877
ADMINISTRATOR/
DIRECTOR:		AQUINO, CARRIE AFACILITY TYPE:
772
ADDRESS:2181 TICE VALLEY BLVDTELEPHONE:
(925) 478-3795
CITY:WALNUT CREEKSTATE: CAZIP CODE:
94595
CAPACITY: 12CENSUS: 8DATE:
10/14/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:00 AM
MET WITH:Administrator Carrie AquinoTIME VISIT/
INSPECTION COMPLETED:
12:30 PM
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On 10/14/2023 at 8:00 AM, Licensing Program Analyst (LPA) J. Sampair arrived unannounced to conduct the Required Annual Inspection of the facility. Upon arrival, LPA stated the purpose of the visit to Staff Members Dara Stanton and Kingsley Nwala. Administrator (ADM) Carrie Aquino arrived at approximately 9:30 AM.

The LPA toured the interior and exterior of the 3 buildings on the facility grounds, including but not limited to client bedrooms, bathrooms, dining area, activity rooms, kitchen, common areas, and outdoor areas. The LPA observed adequate lighting in all of the rooms for the comfort and safety of the clients. LPA observed 7 days of nonperishable and 2 days of perishable foods on hand. Sharps and dangerous items were inaccessible to clients. Client rooms were observed to be cleaned and fully furnished. Indoor and outdoor passages were free of obstruction. There were no bodies of water observed.

Smoke detectors and carbon monoxide detectors were fully functional. Fire extinguishers were observed to be full and last serviced on 8/20/2024. Temperature in the facility was measured at 72.1 degrees Fahrenheit at 10:34 AM and the hot water measured at 108.5 degrees Fahrenheit at 10:31 AM.

The LPA reviewed the records of 5 clients and 5 staff members. The LPA interviewed 3 staff members. Because clients were on an off-site outing when LPA attempted to conduct interviews, no clients were interviewed.

No citations were issued.

Exit interview conducted and a copy of this report provided.
SUPERVISORS NAME: Harpreet Humpal
LICENSING EVALUATOR NAME: James Sampair
LICENSING EVALUATOR SIGNATURE: DATE: 10/14/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/14/2024
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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