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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 079201043
Report Date: 04/12/2023
Date Signed: 04/12/2023 02:06:01 PM

Document Has Been Signed on 04/12/2023 02:06 PM - It Cannot Be Edited

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:D + V ENHANCEMENT SERVICESFACILITY NUMBER:
079201043
ADMINISTRATOR:TING, VICKY S.FACILITY TYPE:
775
ADDRESS:4851-B LONE TREE WAYTELEPHONE:
(925) 813-1979
CITY:ANTIOCHSTATE: CAZIP CODE:
94531
CAPACITY: 50CENSUS: 18DATE:
04/12/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:30 AM
MET WITH:Vicky Ting, AdministratorTIME COMPLETED:
02:30 PM
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On 04/12/23 at 10:30AM, Licensing Program Analyst (LPA) Daisy Panlilio conducted an unannounced required annual inspection and met with administrator (ADM). LPA explained the purpose of the visit with ADM.

During visit, LPA observed a COVID-19 screening station with visitor's log, box of gloves, face masks, hand sanitizer and no touch temperature probe for staff and visitors' use. LPA observed a total of 18 clients in wheelchairs and 8 staff wearing face masks at the facility.

LPA toured the facility with ADM including but not limited to clients' activity room, sensory/relaxation room, theater room, changing rooms (4), medication room, locker room, office, stimulation room, bathrooms (2) and kitchen. LPA observed adequate lighting in the facility with room temperature at 69 deg F. LPA observed several clients engaged in morning activities in the main room with 6 staff wearing face masks assisting clients. Indoor passageways were observed free of obstruction.

LPA observed locked storage cabinets for cleaning supplies, disinfectants and clients' medications Auditory signals on front entrance and exit were operational. Smoke and carbon monoxide detectors were tested operational. First aid kits (2) were complete. LPA observed hot water temperature measured at 109.4 degrees F in the bathrooms.


Continued on next page, LIC 809-C
SUPERVISORS NAME: Bennett Fong
LICENSING EVALUATOR NAME: Daisy Panlilio
LICENSING EVALUATOR SIGNATURE: DATE: 04/12/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/12/2023
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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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: D + V ENHANCEMENT SERVICES
FACILITY NUMBER: 079201043
VISIT DATE: 04/12/2023
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LPA observed diapers and hygiene products stored in locked cabinets for clients' use in changing rooms. The facility has designated male and female bathrooms equipped with paper towels with holders, trash bins with lids opened by foot pedals, proper hand washing poster and no touch soap dispensers. LPA observed 5 fire extinguishers fully charged located in the kitchen/common areas and last inspected on 01/03/23.

Chemical supplies were observed locked and separate from food supplies. Equipment and supplies for clients' personal hygiene were observed available and on site inside the changing rooms.

There were activity materials observed inside the activity room. Emergency/Disaster plans and contact information were observed posted on the bulletin board in the common area. Emergency exit plans were also prominently displayed along with complaint poster and personal rights. Facility has 3 flashlights available and operational for emergency use.

No deficiencies cited during visit.

Exit interview conducted and a copy of this report provided.
SUPERVISORS NAME: Bennett Fong
LICENSING EVALUATOR NAME: Daisy Panlilio
LICENSING EVALUATOR SIGNATURE:

DATE: 04/12/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/12/2023
LIC809 (FAS) - (06/04)
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