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

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 079201196
Report Date: 01/17/2023
Date Signed: 01/17/2023 01:12:34 PM


Document Has Been Signed on 01/17/2023 01:12 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:COGIR OF BRENTWOODFACILITY NUMBER:
079201196
ADMINISTRATOR:MARTINO, AMANDAFACILITY TYPE:
740
ADDRESS:150 CORTONA WAYTELEPHONE:
(925) 240-0733
CITY:BRENTWOODSTATE: CAZIP CODE:
94513
CAPACITY:150CENSUS: 95DATE:
01/17/2023
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
10:15 AM
MET WITH:Amanda Martino, Executive DirectorTIME COMPLETED:
12:50 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 01/17/2023 starting at 10:15AM, Licensing Program Analysts (LPAs) C. Fowler and L. Alexander arrived unannounced to conduct a Prelicensing Inspection due change of ownership. LPAs met with Executive Director (ED), Amanda Martino and explained the purpose of the visit. The facility currently has existing clients. The fire clearance is approved.

LPAs toured facility with ED including but not limited to 4 client apartments, 2 common bathrooms, kitchen, common areas and courtyard. Apartments were equipped with the proper furniture. Bathrooms were equipped with grab bars and non-skid mats. PPE was observed stored in the hallway storage. There is sufficient lighting throughout facility. Central medication storage room will be locked when no staff present. Room temperature is maintained at 76 degrees F and hot water temperature is maintained at 108.9 degrees F. First-aid kit was observed to be complete. Swimming pool area was lock and inaccessible to residents. Smoke detectors and carbon monoxide were operational during visit. Fire extinguisher was last serviced on 01/13/2023.

No issues noted during inspection. LPAs observed that facility is ready to be licensed. This report will be submitted to the Central Applications Bureau (CAB) and a final review of the application will be conducted. This facility is not yet licensed, and is subject to final approval by CAB. Additional requirements may still be required.



Exit interview conducted and a copy of this report provided.
SUPERVISOR'S NAME: Bennett FongTELEPHONE: (510) -62-2621
LICENSING EVALUATOR NAME: Carol FowlerTELEPHONE: (510) 622-2715
LICENSING EVALUATOR SIGNATURE:
DATE: 01/17/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/17/2023
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