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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 079201308
Report Date: 10/10/2024
Date Signed: 10/10/2024 12:56:00 PM

Document Has Been Signed on 10/10/2024 12:56 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:EL REY HOME, THEFACILITY NUMBER:
079201308
ADMINISTRATOR/
DIRECTOR:		HAMILTON, LORELLFACILITY TYPE:
735
ADDRESS:2717 EL REY STREETTELEPHONE:
(925) 775-4674
CITY:ANTIOCHSTATE: CAZIP CODE:
94509
CAPACITY: 6CENSUS: 0DATE:
10/10/2024
TYPE OF VISIT:PrelicensingANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
11:00 AM
MET WITH:Lorell Hamilton, AdministratorTIME VISIT/
INSPECTION COMPLETED:
12:55 PM
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On 10/10/2024 at 11:00am, Licensing Program Analyst (LPA) L. Hall and conducted an continued announced pre-licensing inspection and met with Lorell Hamilton, Administrator. Facility's fire clearance is for six (6) ambulatory clients.

LPA inspected the facility inside and out including but not limited to the bedrooms, bathrooms, common living areas, kitchen, garage, back yard. The facility has a total of three (3) bedrooms and one (1) bathrooms. No bodies of water observed. There is sufficient lighting around the facility. Clients rooms are equipped with the bedding and lighting. Bathrooms showers/tubs were equipped with non skid mats. Passageways and hallways are free of obstruction. Locked cabinets available to store medication, toxins and sharps. Hot water temperature is measured at 132.4 degrees Fahrenheit in shared clients' bathroom. Fire extinguisher was last purchased on 10/10/2024. There is a minimum of 7-day non-perishables and 2-day perishables foods. First Aid kit was complete. Carbon monoxide and smoke detectors present. Facility inspection matches the sketch that was provided.

LPA observed the following need to completed by 10/24/2024.
  • Water temperature need to be adjusted between 105 - 120 degrees F.
  • Purchase of linen to permit changing the linen at least once each week or more often when necessary.

Continued on LIC809C.
SUPERVISORS NAME: Harpreet Humpal
LICENSING EVALUATOR NAME: Laura Hall
LICENSING EVALUATOR SIGNATURE: DATE: 10/10/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/10/2024
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: EL REY HOME, THE
FACILITY NUMBER: 079201308
VISIT DATE: 10/10/2024
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Continued from LIC809.
  • Drawer space for each client a minimum of two drawers or eight cubic feet of drawer space.
  • Ramp located in back yard needs handles repaired.

Issues were noted during inspection. LPA observed that facility is not ready to be licensed. This report will be submitted to the Central Applications Unit (CAU) and a final review of the application will be conducted. This facility is not yet licensed and is subject to final approval by CAU. Additional requirements may still be required.

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

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

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