<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 079201335
Report Date: 03/06/2025
Date Signed: 03/06/2025 12:31:12 PM

Document Has Been Signed on 03/06/2025 12:31 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:1ST CHOICEFACILITY NUMBER:
079201335
ADMINISTRATOR/
DIRECTOR:		PIPER, TONIEFACILITY TYPE:
735
ADDRESS:4639 GLASGOW COURTTELEPHONE:
(917) 676-9966
CITY:ANTIOCHSTATE: CAZIP CODE:
94531
CAPACITY: 6CENSUS: 0DATE:
03/06/2025
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
11:00 AM
MET WITH:Andrea White, Licensee/AdministratorTIME VISIT/
INSPECTION COMPLETED:
12:50 PM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
On 03/06/25 at 11AM. Licensing Program Analyst (LPA) Daisy Panlilio arrived announced to conduct a pre-licensing inspection. LPA met with Administrator (ADM) and explained the purpose of the visit. The facility currently has no clients. ADM stated they are waiting for the Assisted Living Program approval for future clients.

At 11:25AM, LPA toured the facility with ADM including but not limited to the clients' bedrooms, common areas, kitchen, and outdoor area. LPA observed a screening station near the front entrance with a no touch temperature probe, visitors' log and hand sanitizer. Indoor and outdoor passageways were observed free of obstruction. There were no bodies of water observed. LPA advised ADM that hot water temperature should be maintained between 105 degrees F and 120 degrees F. Since there are no clients and staff at the facility, ADM agrees to provide 2 days supply of perishable and one week supply of non-perishable foods. Towels, sheets, activity supplies and hygiene products were observed available.

The facility has 3 full bathrooms. LPA observed the shower area has non-skid floor tiles. There are activity materials observed in the living room. Facility has flashlights available for emergency use. There is sufficient lighting throughout facility. First-aid kit was observed complete. Smoke detectors and carbon monoxide were operational. Fire extinguisher was observed fully charged. Proper hand-washing signs, Emergency/Disaster plans/contact information, personal rights were observed posted in common areas.

No deficiency cited during visit.

Exit interview conducted and a copy of this report provided.
SUPERVISORS NAME: Bennett Fong
LICENSING EVALUATOR NAME: Daisy Panlilio
LICENSING EVALUATOR SIGNATURE: DATE: 03/06/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/06/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 1