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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 079201268
Report Date: 05/16/2023
Date Signed: 05/16/2023 10:36:21 AM

Document Has Been Signed on 05/16/2023 10:36 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
CCLD Regional Office, 1515 CLAY STREET, STE. 310
OAKLAND, CA 94612
FACILITY NAME:G & O RESIDENTIAL CARE, INCFACILITY NUMBER:
079201268
ADMINISTRATOR:GARCIA, OVILIO BARRIOSFACILITY TYPE:
735
ADDRESS:1550 LARKSPUR CTTELEPHONE:
(925) 565-5731
CITY:OAKLEYSTATE: CAZIP CODE:
94561
CAPACITY: 4CENSUS: 0DATE:
05/16/2023
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
08:25 AM
MET WITH:Ovilio Garcia, Licensee/AdministratorTIME COMPLETED:
10:00 AM
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On 5/16/2023 at 8:25AM, Licensing Program Analyst (LPA) G. Luk conducted an announced Pre-licensing Inspection. LPA met with Licensee/Administrator, Ovilio Garcia. LPA inspected the facility inside and out including but not limited to bedrooms, bathrooms, dining room, kitchen, living room, garage, and outdoor area. Hot water temperature was measured at 119.9 degrees F. Facility has a locked cabinet in the kitchen for Medications. First aid kit was complete. Fire extinguisher was observed to the full and last serviced on 4/11/2023. Smoke and carbon monoxide combination detectors were observed. No bodies of water observed. Disaster plan was completed on 4/28/2023. Home was clean and well ventilated with appropriate lighting. Licensee purchased surety bond on February 14, 2023.

Facility has some non-perishable and perishable food supplies. Licensee will purchase additional food supplies prior to admitting clients. There were appropriate number of utensils, plates, bowls, and cups at the facility.

No issues noted during inspection. LPA observed that facility is ready to be licensed. This report will be submitted to the Centralized Application 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.
SUPERVISORS NAME: Harpreet Humpal
LICENSING EVALUATOR NAME: Grace Luk
LICENSING EVALUATOR SIGNATURE: DATE: 05/16/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/16/2023
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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