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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 079201145
Report Date: 09/05/2024
Date Signed: 09/05/2024 09:50:56 AM

Document Has Been Signed on 09/05/2024 09:50 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
OAKLAND ASC, 1515 CLAY STREET, STE. 310
OAKLAND, CA 94612
FACILITY NAME:HEARTWOOD VILLASFACILITY NUMBER:
079201145
ADMINISTRATOR/
DIRECTOR:		ARNANTE, CLAUDIOFACILITY TYPE:
735
ADDRESS:1561 HEARTWOOD DRIVETELEPHONE:
(925) 687-1230
CITY:CONCORDSTATE: CAZIP CODE:
94521
CAPACITY: 4CENSUS: 4DATE:
09/05/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:00 AM
MET WITH:Caregiver, Lita DelfinTIME VISIT/
INSPECTION COMPLETED:
10:00 AM
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On 09/05/2024 at 8:00 AM, Licensing Program Analyst (LPA) A. Gomez arrived unannounced to conduct Required 1 Year Annual inspection. Upon arrival LPA was greeted by Caregiver, Lita Delfin. LPA spoke to the Administrator, Claudio Arnante, on the phone and explained the purpose of the visit. Administrator was unable to join visit and allowed Lita Delfin to sign the report. The facility’s fire clearance was approved for 4 Ambulatory. Clients were at day program during visit.

LPA toured the facility including but not limited to bedrooms, bathrooms, kitchen, common area and backyard. The facility consists of 5 total bedrooms which 4 bedrooms are occupied by the clients and 1 bedroom is occupied by staff. All outdoor and indoor passageways are kept free of obstruction. There are no bodies of water. A comfortable temperature for clients is maintained at 75 degree Fahrenheit. LPA observed lighting in all rooms are adequate for the comfort and safety of the clients. Hot water temperature in the shared clients’ bathroom was measured at 109.2 degree Fahrenheit. All toilets, hand washing stations, and bathing stations are safe, sanitary and in operating condition. The supply of extra hygiene’s were available for clients. There is a minimum of 7 day supply of non-perishables and 2 day perishables food supply.

Smoke detectors and carbon monoxide were in operating condition during visit. Fire extinguisher was last serviced on 8/8/2024. Emergency Disaster Plan was last posted on 9/25/2023. First aid kit was observed to be complete. Fire drill was last conducted in May of 2024.

At 8:20 AM, LPA reviewed 4 of 4 residents records. At 9:00 AM, LPA reviewed 4 staff records and 4 of 4 have current first aid training and associated to the facility. At 8:40 AM, LPA reviewed P & I money and log with Lita. The facility has sufficient amount of surety bond to cover the cash being handled at one time.

No deficiencies cited during visit. Exit interview conducted and a copy of this report provided.
SUPERVISORS NAME: Yvonne Flores-Larios
LICENSING EVALUATOR NAME: Alona Gomez
LICENSING EVALUATOR SIGNATURE: DATE: 09/05/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/05/2024
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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