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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 079201005
Report Date: 01/05/2021
Date Signed: 01/05/2021 03:00:34 PM

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:CARELINK ASSISTED LIVINGFACILITY NUMBER:
079201005
ADMINISTRATOR:ALABBAS, FADIFACILITY TYPE:
740
ADDRESS:3101 BOWLING GREEN DRTELEPHONE:
(925) 765-9618
CITY:WALNUT CREEKSTATE: CAZIP CODE:
94598
CAPACITY:6CENSUS: 0DATE:
01/05/2021
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
01:05 AM
MET WITH:Fadi Alabbas, LicenseeTIME COMPLETED:
03:00 PM
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On 1/5/2021, Licensing Program Analyst (LPA) L. Francisco conducted a Tele-visit Pre-Licensing inspection via Zoom due to shelter in place directed by the Governor. LPA spoke with Fadi Alabbas. The facility's fire clearance was approved for six ambulatory.

During the Tele-Inspection, LPA toured facility with Administrator including but not limited to bedrooms, bathroom, common areas, kitchen, and outdoor area. Resident's bedrooms are fully furnished with bed, dresser, night stand, and chair. Facility currently has no residents. Residents bathroom were equipped with grab bars and non-skid mat. LPA observed lighting in all rooms. Medications will be stored and locked in the storage room right next to the kitchen area. Smoke detectors are interconnected. Carbon Monoxide detector was observed and in operation condition. First aid kit is complete. LPA advised Administrator that hot water temperature should be maintained between 105 degrees F and 120 degrees F. Indoor and outdoor passageways were free of obstruction. Fire extinguisher was observed to be full. Emergency disaster plan is current.

LPA conducted Component III with Licensee during Tele-visit. LPA presented Component III Power Point and discussed the regulations embodied in the presentation.

This report will be submitted to the Centralized Application Bureau (CAB) and a final review of the application will be conducted. This facility is not yet licensed and is subject to final approval by CAB. Additional requirements may still be required.

Exit interview conducted and a copy of report will be emailed.

SUPERVISOR'S NAME: Harpreet HumpalTELEPHONE: (510) 285-3928
LICENSING EVALUATOR NAME: Lizette FranciscoTELEPHONE: (510) 286-4201
LICENSING EVALUATOR SIGNATURE:

DATE: 01/05/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/05/2021
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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