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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 079201258
Report Date: 11/06/2023
Date Signed: 11/06/2023 11:54:29 AM


Document Has Been Signed on 11/06/2023 11:54 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:MARINA CARE HOMEFACILITY NUMBER:
079201258
ADMINISTRATOR:COLLADO, CHARMAINEFACILITY TYPE:
740
ADDRESS:1850 MARINA CTTELEPHONE:
(925) 349-6644
CITY:CONCORDSTATE: CAZIP CODE:
94520
CAPACITY:6CENSUS: 6DATE:
11/06/2023
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
09:25 AM
MET WITH:Charmaine Collado, AdministratorTIME COMPLETED:
11:30 AM
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On 11/06/2023 at 9:25 AM, Licensing Program Analyst (LPA) P. Watson arrived unannounced to conduct Pre-Licensing inspection. LPA met with Administrator, Charmaine Collado and explained the purpose of the visit. The facility currently has 6 residents.

LPA toured facility with Charmaine including but not limited to 7 bedrooms, 3 bathrooms, kitchen, common areas and backyard. Bedrooms and living rooms were equipped with the proper furniture. Bathrooms were equipped with grab bars and non-skid mats. Linens and hygiene supplies were observed inside a closet. There is sufficient lighting throughout facility. A comfortable temperature for residents was maintained at 74 degrees Fahrenheit. Hot water temperature in the residents shared bathroom was maintained at 117.8 and 115.3 degrees Fahrenheit. First-aid kit was observed to be complete. Smoke detectors and carbon monoxide were operational. Fire extinguisher was last purchased on 10/23/2023.


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: Yvonne Flores-LariosTELEPHONE: (510) 725-7926
LICENSING EVALUATOR NAME: Paris WatsonTELEPHONE: (510) 622-2625
LICENSING EVALUATOR SIGNATURE:
DATE: 11/06/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/06/2023
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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