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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 079200895
Report Date: 08/20/2021
Date Signed: 08/20/2021 12:00:22 PM

Document Has Been Signed on 08/20/2021 12:00 PM - 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:SACRED HANDS LIVING IIIFACILITY NUMBER:
079200895
ADMINISTRATOR:PANESAR, RAJWANT KAURFACILITY TYPE:
740
ADDRESS:536 LAKE PARK CTTELEPHONE:
(209) 762-2910
CITY:OAKLEYSTATE: CAZIP CODE:
94561
CAPACITY: 6CENSUS: 0DATE:
08/20/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:15 AM
MET WITH:PANESAR, RAJWANT KAURTIME COMPLETED:
12:15 PM
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On 8/20/2021 at 10:15 AM Licensing Program Analyst (LPA) Leslie Ibo arrived unannounced to conduct an annual infection control inspection. LPA met with Administrator PANESAR, RAJWANT KAUR. Facility do not have any residents in care, per Administrator the last residents they had was last March 2021.

LPA toured the facility inside and out including but not limited to common areas, resident rooms, bathrooms, garage ,kitchen and backyard. Facility has enough supplies of PPEs, paper supplies and hygiene supplies. Medications are can be centrally stored in a locked area.

Facility has enough one-week non-perishable food supply LPA reminded Administrator to make sure to have available 2 days perishable food for residents in care once she starts admitting new residents. Visitors policy is posted on the front entrance. There is one central entry point for universal screening for staff, residents and visitors. A sign-in policy, thermometer and hand sanitizer were observed at screening station. Cough/sneeze etiquette, social distancing and hand washing posters were observed. Facility staff were observed to be wearing proper PPE. Facility has a mitigation plan and maintains record of routine screening for residents and staff.

No deficiency cited during the visit.

Exit interview conducted. Appeal Rights and copy of this report provided.
SUPERVISORS NAME: Harpreet Humpal
LICENSING EVALUATOR NAME: Leslie Ibo
LICENSING EVALUATOR SIGNATURE: DATE: 08/20/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/20/2021
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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