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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 079201287
Report Date: 10/22/2024
Date Signed: 10/22/2024 10:44:24 AM

Document Has Been Signed on 10/22/2024 10:44 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:HIGHGATE HOMEFACILITY NUMBER:
079201287
ADMINISTRATOR/
DIRECTOR:		TAMBOT-SUNGA,DEYRAFACILITY TYPE:
735
ADDRESS:3938 HIGHGATE WAYTELEPHONE:
(925) 635-3724
CITY:PITTSBURGSTATE: CAZIP CODE:
94565
CAPACITY: 6CENSUS: 0DATE:
10/22/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:45 AM
MET WITH:Rowell Ferrer, LicenseeTIME VISIT/
INSPECTION COMPLETED:
10:55 AM
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On 10/22/2024 at 09:45am, Licensing Program Analyst (LPA) L. Hall conducted an unannounced annual required inspection. LPA met with Rowell Ferrer, Licensee, and explained the purpose of the visit. Administrator holds a certificate 6022157735 that expires on 12/15/2024. The facility’s fire clearance was approved for six (6) non-ambulatory clients. Facility does not have any clients and is not operating at this time.

LPA toured the facility including but not limited to bedrooms, bathrooms, kitchen, common area, garage, and back yard. The facility consists of four (4) bedrooms and two (2) bathrooms. All indoor passageways are kept free of obstruction. There are no bodies of water. A comfortable temperature for in facility is maintained at 72 degrees 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 110.8 degrees Fahrenheit. All toilets, hand washing, and bathing are safe, sanitary and in operating condition. The supply of extra hygiene was available for residents.

Smoke detectors/carbon monoxide were in operating condition during visit. Fire extinguisher was last serviced on 2/6/2024. First aid kit was observed to be complete.

Continued on LIC809C.
SUPERVISORS NAME: Harpreet Humpal
LICENSING EVALUATOR NAME: Laura Hall
LICENSING EVALUATOR SIGNATURE: DATE: 10/22/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/22/2024
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1515 CLAY STREET, STE. 310
OAKLAND, CA 94612
FACILITY NAME: HIGHGATE HOME
FACILITY NUMBER: 079201287
VISIT DATE: 10/22/2024
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Continued from LIC809.

LPA reviewed two (2) staff files both were current and complete.

The following forms to be updated and submitted to CCLD by 10/29/2024:
  • LIC610D Emergency disaster plan
  • LIC308 (Designation of facility Responsibility)


No deficiencies cited during visit.

Exit interview conducted and a copy of this report provided.
SUPERVISORS NAME: Harpreet Humpal
LICENSING EVALUATOR NAME: Laura Hall
LICENSING EVALUATOR SIGNATURE:

DATE: 10/22/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/22/2024
LIC809 (FAS) - (06/04)
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