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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 079201027
Report Date: 11/11/2020
Date Signed: 11/16/2020 07:02:06 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:NAVAJO CARE HOMEFACILITY NUMBER:
079201027
ADMINISTRATOR:CHAUDHRY, TAYYABAFACILITY TYPE:
740
ADDRESS:3 NAVAJO COURTTELEPHONE:
(925) 433-6000
CITY:ALAMOSTATE: CAZIP CODE:
94507
CAPACITY:6CENSUS: 0DATE:
11/11/2020
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
03:00 PM
MET WITH:Tayyaba Chaudhry, AdministratorTIME COMPLETED:
03:30 PM
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On 11/11/2020 at 03:00pm, Licensing Program Analyst (LPA) L. Hall conducted an announced pre-licensing tele-inspection through Facetime due to the shelter in place order directed by the Governor. LPA met with Tayyaba Chaudhry, Administrator. The facility has an approved fire safety clearance for six (6) residents five (5) non-ambulatory and one (1) bedridden.

LPA started the inspection with Administrator with bedroom #1. Five (5) out of six (6) bedrooms was not furnished. Administrator only had one (1) of six (6) bedrooms furnished. LPA discontinued inspection.

LPA advised Administrator that all bedrooms need to be furnished before inspection can be continued.

Issues were noted during inspection. LPA observed that facility is not 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 Administrators and a copy of this report will be emailed.
SUPERVISOR'S NAME: Harpreet HumpalTELEPHONE: (510) 285-3928
LICENSING EVALUATOR NAME: Laura HallTELEPHONE: (510) 622-2024
LICENSING EVALUATOR SIGNATURE:

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

DATE: 11/11/2020
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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