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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 079200895
Report Date: 08/18/2022
Date Signed: 08/18/2022 02:02:58 PM

Document Has Been Signed on 08/18/2022 02:02 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:
08/18/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
11:46 AM
MET WITH: PANESAR, RAJWANT KAUR, Administrator TIME COMPLETED:
02:10 PM
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On 8/18/2022 at 11:46 AM Licensing Program Analyst (LPA) L. 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, kitchen and backyard. No bodies of water. Facility has enough supplies of PPEs, paper supplies and hygiene supplies. No medications for residents during the visit but there are centrally stored in a locked area inside the facility.

Since facility do not have any clients for almost a year, facility has don’t have 2-day perishable food and one-week non-perishable food supply, LPA advised Administrator that once facility have new clients, this regulation should be followed.

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 LPA requested copy of infection control plan by 8/26/2022.

No deficiency cited during the visit.

Exit interview conducted. Copy of this report provided.
SUPERVISORS NAME: Harpreet Humpal
LICENSING EVALUATOR NAME: Leslie Ibo
LICENSING EVALUATOR SIGNATURE: DATE: 08/18/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/18/2022
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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