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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 079200940
Report Date: 06/24/2022
Date Signed: 06/24/2022 03:43:08 PM


Document Has Been Signed on 06/24/2022 03:43 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:NEW ALAMO RESIDENCE HOMEFACILITY NUMBER:
079200940
ADMINISTRATOR:SAXENA, MEERANFACILITY TYPE:
740
ADDRESS:836 STONE VALLEY RDTELEPHONE:
(925) 743-1565
CITY:ALAMOSTATE: CAZIP CODE:
94507
CAPACITY:6CENSUS: 6DATE:
06/24/2022
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
12:25 PM
MET WITH:Meeran Saxena, AdministratorTIME COMPLETED:
04:00 PM
NARRATIVE
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On 6/24/2022 at 12:25 PM, Licensing Program Analyst (LPA) L. Francisco arrived unannounced to conduct a Case Management visit. Upon arrival, LPA was greeted by Care Staff, Irene Joseph. Administrator, Meeran Saxena later arrived at 12:40 PM

The Department conducted interviews and record during the course of investigation for complaint (#15-AS-20211222084738), the following deficiency was observed. Based on record review, S1 is not fingerprint cleared. S1 stated S1 has been living and employed with the facility since 11/05/2022. According to S2, S1 was employed on 11/15/2021. Although dates of employment are conflicting, record review shows that S1 is not cleared and The Department observed S1 working at the facility on 12/21/2021.

The deficiency was observed (see LIC 809D) and cited from the California Code of Regulations, Title 22. Failure to correct deficiency may result in civil penalties.

A $500 Civil Penalty is being observed

Administrator authorized Care Staff, Irene Joseph to sign report.

Exit interview conducted with Care Staff. A copy of this report and appeal rights provided.
SUPERVISOR'S NAME: Harpreet HumpalTELEPHONE: (510) 285-3928
LICENSING EVALUATOR NAME: Lizette FranciscoTELEPHONE: (510) 286-4201
LICENSING EVALUATOR SIGNATURE:
DATE: 06/24/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/24/2022
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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Document Has Been Signed on 06/24/2022 03:43 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1515 CLAY STREET, STE. 310
OAKLAND, CA 94612


FACILITY NAME: NEW ALAMO RESIDENCE HOME
FACILITY NUMBER: 079200940

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/24/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Deficiency Dismissed
Type A
06/25/2022
Section Cited

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CRIMINAL RECORD CLEARANCE
(e) All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1569.17(b) shall prior to working, residing.. (1) Obtain a California clearance or a criminal record exemption as required by the Department or
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Deficiency cleared. S1 was removed from facility on 12/22/2021. On 12/27/2021, LPA confirmed S1 is no longer at the facility.

A $500 Civil Penalty is assessed.
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This requirement is not met as evidenced by: Based on the Deparments record review and observation, Licensee did not comply with the regulation above. S1 has been employed at the facility without fingerprint clearance since November 2021. S1 was observed by the Department on 12/21/2021 which poses an immediate health and safety risk to persons in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME: Harpreet HumpalTELEPHONE: (510) 285-3928
LICENSING EVALUATOR NAME: Lizette FranciscoTELEPHONE: (510) 286-4201
LICENSING EVALUATOR SIGNATURE:
DATE: 06/24/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/24/2022
LIC809 (FAS) - (06/04)
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