<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 079200995
Report Date: 11/13/2020
Date Signed: 11/13/2020 11:28:36 AM

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:CAREFRONT RESIDENTIAL LIVINGFACILITY NUMBER:
079200995
ADMINISTRATOR:WANG, DINGFACILITY TYPE:
740
ADDRESS:4086 TULARE DRTELEPHONE:
(935) 890-8953
CITY:CONCORDSTATE: CAZIP CODE:
94521
CAPACITY:6CENSUS: 0DATE:
11/13/2020
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Ding WangTIME COMPLETED:
11:30 AM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
On 11/13/2020 at 9:00AM, Licensing Program Analyst (LPA) Roland Pitcher conducted a Tele-visit Pre-Licensing inspection via Face Time due to shelter in place directed by the Governor. LPA spoke with Applicant, Ding Wang for this purpose.

At 9:20AM, LPA toured the physical plant, but not limited to 5 bedrooms, 2 bathrooms equipped for non-ambulatory clients, kitchen, 2 living rooms, laundry room, garage and spacious backyard. There are no pool or bodies of water.

LPA observed the kitchen is equipped with utensils, cook ware, dinnerware, glasses.
LPA observed locking cabinets in the kitchen to secure knives. Centrally stored medication will be locked in the hallway closet and cleaning supplies will be locked under the kitchen sink cabinet. First aid kit is complete with tweezer, scissors, thermometer, etc.

There is a sufficient supply of non-perishable food, hygiene supplies, linen, towels, blankets. Activities include board games, karaoke. LPA observed the home will provide live piano entertainment.

Hot water temperature was measured at degrees Fahrenheit in resident bathroom sink, which is within the required range of 105 to 120 degrees. Fire extinguishers and smoke detectors are current and in compliance with fire safety including the presence of carbon monoxide detector.

Report continued on LIC 809C
SUPERVISOR'S NAME: Julio MontesTELEPHONE: (510) 286-0518
LICENSING EVALUATOR NAME: Rolanda PitcherTELEPHONE: (510) 542-0253
LICENSING EVALUATOR SIGNATURE:

DATE: 11/13/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/13/2020
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC809 (FAS) - (06/04)
Page: 1 of 2
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: CAREFRONT RESIDENTIAL LIVING
FACILITY NUMBER: 079200995
VISIT DATE: 11/13/2020
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
Component III was conducted with Ding Wang.

This report will be submitted to the Central Applications Unit (CAU) and a final review of the application will be conducted. This facility is not yet licensed, and is subject to final approval by Centralized Application Unit.


Exit interview was conducted with Ding Wang.
SUPERVISOR'S NAME: Julio MontesTELEPHONE: (510) 286-0518
LICENSING EVALUATOR NAME: Rolanda PitcherTELEPHONE: (510) 542-0253
LICENSING EVALUATOR SIGNATURE:

DATE: 11/13/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/13/2020
LIC809 (FAS) - (06/04)
Page: 2 of 2