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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 079201005
Report Date: 01/13/2022
Date Signed: 01/14/2022 08:31:14 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: 4DATE:
01/13/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH:FADI ALABBASTIME COMPLETED:
04:45 PM
NARRATIVE
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On 1/13/2022 at 1:00PM, Licensing Program Analyst (LPA) James Sampair arrived unannounced for an Infection Control Annual Inspection. The facility has a completed COVID-19 mitigation plan (LIC 808), but the Licensee, Fadi Alabbas, has not implemented an infection control plan at the facility and neither he nor any of his staff have been following the Department or Public Health Department Covid-19 infection control guidelines at the facility.

No signs informing visitors of Covid-19 infection control guidelines were at the front door. The LPA was greeted at the door by the only staff member present, S1, who was not wearing a mask. No visitor log nor any PPE, or hand sanitizer present. Very few Covid-19 signs were posted in the facility to promote hand washing, cough and sneeze etiquette, physical distancing, or mask wearing. For that reason, the facility was cited on numerous violations of Title 22 regulations concerning the care and protection of the residents.

Additionally, the LPA discovered that S1 had not been associated with the facility, so S1 left after the Licensee arrived at approximately 1:15PM. The inspection of the facility inside and out was then conducted with Mr. Alabbas.

During the inspection, the LPA discovered numerous other offenses at the facility that were more than he was able to address on that day, so he departed at 4:45PM after completing an exit interview with Mr. Alabbas.

This report was completed, signed, and a copy given to Mr. Alabbas on the following day, 01/14/2022.
SUPERVISOR'S NAME: Harpreet HumpalTELEPHONE: (510) 285-3928
LICENSING EVALUATOR NAME: James SampairTELEPHONE: (510) 286-4201
LICENSING EVALUATOR SIGNATURE:

DATE: 01/14/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/14/2022
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 4
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: CARELINK ASSISTED LIVING
FACILITY NUMBER: 079201005
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/13/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
CCR
87468.1(a)(2)
Personal Rights of Residents in all Facilities
(a) Residents in all residential care facilities for the elderly shall have all of the following personal rights: (2) To be accorded safe, healthful and comfortable accommodations, furnishings and equipment.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, the licensee did not comply with the section cited above because facility does not have a functioning mitigation plan being used to mitigate the spread of COVID-19 in the facility, which poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date: 01/21/2022
Plan of Correction
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Licensee shall create a full COVID-19 mitigation plan that is in alignment with current Departmental and CDPH guidelines that has been trained to and actively followed by all staff.
Type A
Section Cited
CCR
87355(c)
87355 CRIMINAL RECORD CLEARANCE (c) A licensee or applicant for a license may request a transfer of a criminal record clearance from one state licensed facility to another

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, the licensee did not comply with the section cited above with a staff person (S1), which poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date: 01/13/2022
Plan of Correction
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Remove staff person (S1) from facility and associate S1 with facility before returning to facility.
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: James SampairTELEPHONE: (510) 286-4201
LICENSING EVALUATOR SIGNATURE:
DATE: 01/14/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/14/2022
LIC809 (FAS) - (06/04)
Page: 2 of 4
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: CARELINK ASSISTED LIVING
FACILITY NUMBER: 079201005
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/13/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
87411(d)(5)
Personnel Requirements - General
(d) All personnel shall be given on the job training or have related experience in the job assigned to them. This training and/or related experience shall provide knowledge of and skill in the following, as appropriate for the job assigned and as evidenced by safe and effective job performance: (5) Knowledge necessary in order to recognize early signs of illness and the need for professional help.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on interview, the licensee did not comply with the section cited above because the facility does not have procedures for when to test staff, and residents to monitor the spread of the virus and mitigate outbreaks, which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 01/21/2022
Plan of Correction
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Licensee shall create a full COVID-19 mitigation plan that is in alignment with current Departmental and CDPH guidelines that has been trained to and actively followed by all staff.
Type B
Section Cited
CCR
87464(f)(1)
Basic Services
(f) Basic services shall at a minimum include: (1) Care and supervision as defined in Section 87101(c)(3) and Health and Safety Code section 1569.2(c).

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, the licensee did not comply with the section cited above because the facility does not have an adequate 30-day supply of PPE (e.g., facemasks, respirators, gowns, gloves, and eye protection such as face shield or goggles) and a list including items on hand, which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 01/21/2022
Plan of Correction
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Licensee shall obtain an adequate 30-day supply of PPE (e.g., facemasks, respirators, gowns, gloves, and eye protection such as face shield or goggles) and a list including items on hand.
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: James SampairTELEPHONE: (510) 286-4201
LICENSING EVALUATOR SIGNATURE:
DATE: 01/14/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/14/2022
LIC809 (FAS) - (06/04)
Page: 3 of 4
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: CARELINK ASSISTED LIVING
FACILITY NUMBER: 079201005
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/13/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
87465(f)(2)
Incidental Medical and Dental Care Services
(f) Emergency care requirements shall include the following: (2) The name, address and telephone number of each emergency agency to be called in the event of an emergency, including but not limited to the fire department, crisis center or paramedical unit or medical resource, shall be posted in a location visible to both staff and residents.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, the licensee did not comply with the section cited above because no Emergency Disaster Plan (LIC610E) or REGISTER OF FACILITY RESIDENTS (LIC9020A) is posted, which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 01/21/2022
Plan of Correction
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Licensee shall post the Emergency Disaster Plan (LIC610E) and REGISTER OF FACILITY RESIDENTS (LIC9020A).
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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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: James SampairTELEPHONE: (510) 286-4201
LICENSING EVALUATOR SIGNATURE:
DATE: 01/14/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/14/2022
LIC809 (FAS) - (06/04)
Page: 4 of 4