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

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 079201027
Report Date: 11/16/2020
Date Signed: 11/16/2020 07:02:52 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:
11/16/2020
TYPE OF VISIT:Case Management - OtherANNOUNCEDTIME BEGAN:
02:00 PM
MET WITH:Tayyaba Chaudhry, AdministratorTIME COMPLETED:
02:30 PM
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 11/16/2020 at 2:00pm, Licensing Program Analyst (LPA), L. Hall, continued an announced pre-licensing tele-inspection from 11/11/2020 at 03:00pm, via Facetime due to the shelter in place order directed by the Governor. LPA met with Tayyaba Chaudhry, Administrator.

LPA inspected the facility inside and out but not limited to bedrooms, common living areas, kitchen, garage and backyard. There was sufficient lighting around the facility. Bathrooms were equipped with grab bars and non-skid mats. Hallways were free of obstruction. Furnishing of the bedrooms was corrected, however, LPA observed washer and dryer not installed in garage. LPA observed 1-gallon paint cans, wood, trash, and other debris on the right-side of the house in the backyard which obstructed the pathway. LPA discontinued the inspection.

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: 11/16/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/16/2020
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 1