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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 079201017
Report Date: 10/30/2020
Date Signed: 10/30/2020 12:00:43 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:AQUINO'S CARE HOMEFACILITY NUMBER:
079201017
ADMINISTRATOR:AQUINO, MARICELFACILITY TYPE:
740
ADDRESS:2481 RAMONA STREETTELEPHONE:
(559) 303-7020
CITY:PINOLESTATE: CAZIP CODE:
94564
CAPACITY:6CENSUS: 5DATE:
10/30/2020
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
10:30 AM
MET WITH:Maricel Aquino, AdministratorTIME COMPLETED:
11:55 AM
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On 10/30/20 at 10:30AM, Licensing Program Analyst (LPA) J. Hamilton conducted an unannounced pre-licensing inspection with facility Administrator, Maricel Aquino. Due to the Governor's shelter-in-place order this inspection was conducted via videoconference.

During the televisit, LPA toured facility with Administrator, including but not limited to the residents' bedrooms, common living area, dinning room, kitchen, garage/laundry area, and outdoor areas. Residents' bedrooms are equipped with proper furniture and bedding. LPA observed lighting in all rooms is adequate for the comfort and safety of the residents. The kitchen was observed clean and within compliance. LPA observed a one week supply of non-perishable and 2-day supply of perishable foods. Bathrooms were equipped with grab bars and non-skid mats. Living room is equipped with the proper furniture residents. There are designated storage areas for chemicals, locked and secure. Indoor and outdoor passageways observed free of obstruction. LPA noted 2 fire extinguishers last inspected June, 2020. LPA observed medications were locked in a secure cabinet. Facility is equipped with a fully stocked first-aid kit. LPA observed smoke detectors throughout the home, and 2 operational carbon monoxide detectors. Administrator acknowledged hot water temperature should be maintained between 105 and 120 degrees F.

Component III has been waived. LPA observed that facility is ready to be licensed. 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 CAU. Additional requirements may still be required.

Exit interview conducted with Administrator by telephone. LPA will email a copy of report to Administrator on today's date.
SUPERVISOR'S NAME: Isaac TaggartTELEPHONE: (510) 622-2610
LICENSING EVALUATOR NAME: Jason HamiltonTELEPHONE: (510) 622-2647
LICENSING EVALUATOR SIGNATURE:

DATE: 10/30/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/30/2020
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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