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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 079201205
Report Date: 09/26/2023
Date Signed: 09/26/2023 11:20:14 AM


Document Has Been Signed on 09/26/2023 11:20 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:LOVING HANDSFACILITY NUMBER:
079201205
ADMINISTRATOR:MORALES, MA MERCEDES R.FACILITY TYPE:
740
ADDRESS:2621 PRESIDIO DRTELEPHONE:
(925) 330-5129
CITY:BRENTWOODSTATE: CAZIP CODE:
94513
CAPACITY:5CENSUS: 5DATE:
09/26/2023
TYPE OF VISIT:Post LicensingUNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Caregiver Lilibeth PadridTIME COMPLETED:
12:00 PM
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On 09/26/2023 at 10:00 AM, Licensing Program Analyst (LPA) J. Sampair arrived unannounced at facility for the post licensing inspection. Upon entering facility, LPA stated purpose of visit to staff member Lilibeth Padrid.

During the Inspection, the LPA inspected the facility inside and outside. LPA observed that the facility has a sufficient supply of food: 2 days perishable and 7 days nonperishable. A comfortable inside temperature of 72.5 degrees F was maintained. The facility was clean and the staff attentive to residents' needs.

On the previous day, 09/26/2023, the LPA had reviewed 4 staff and 5 resident files and interviewed 2 residents and 2 staff, so he did not repeat those tasks again during this visit.

Exit interview conducted with Caregiver Lilibeth Padrid and a copy of this report was provided to Licensee Mercedes Morales via email.
SUPERVISOR'S NAME: Bennett FongTELEPHONE: (510) -62-2621
LICENSING EVALUATOR NAME: James SampairTELEPHONE: (510) 286-4201
LICENSING EVALUATOR SIGNATURE:
DATE: 09/26/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/26/2023
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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