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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 079201145
Report Date: 12/05/2022
Date Signed: 12/05/2022 11:19:25 AM

Document Has Been Signed on 12/05/2022 11:19 AM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
E BAY DELTA AC/SC, 1515 CLAY STREET, STE. 310
OAKLAND, CA 94612
FACILITY NAME:HEARTWOOD VILLASFACILITY NUMBER:
079201145
ADMINISTRATOR:ARNANTE, CLAUDIOFACILITY TYPE:
735
ADDRESS:1561 HEARTWOOD DRIVETELEPHONE:
(925) 687-1230
CITY:CONCORDSTATE: CAZIP CODE:
94521
CAPACITY: 4CENSUS: 4DATE:
12/05/2022
TYPE OF VISIT:Post LicensingUNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Eufemia Santos, Caregiver
Claudio Arnante, Administrator		TIME COMPLETED:
11:30 AM
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On 12/05/2022 at 10:00 AM, Licensing Program Analyst (LPA) P. Watson arrived unannounced and conducted a Post Licensing inspection. LPA was greeted by Eufemia Santos, Caregiver, and explained the purpose of the visit. LPA spoke with Administrator on the phone, Administrator, Claudio Arnante, joined the visit at the end. LPA inspected the facility inside and out. Facility had 4 residents during the inspection. Facility has a sufficient two day perishable and one week non-perishable food supply. Cabinets for knives, cleaning supplies, and central storage for medications were observed with locks. Fire extinguishers were last inspected on 08/16/2022. First aid kit was complete with manual. Carbon monoxide and smoke detectors were interconnected and observed operational during visit.

Facility temperature is maintained at 70 degrees Fahrenheit. Hot water temperature measures 111 degrees Fahrenheit in the kitchen. Each room is provided with working lights. Hallways and passages inside and out are free of obstruction.


No deficiencies cited during visit. Exit interview conducted and a copy of this report provided.
SUPERVISORS NAME: Yvonne Flores-Larios
LICENSING EVALUATOR NAME: Paris Watson
LICENSING EVALUATOR SIGNATURE: DATE: 12/05/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/05/2022
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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