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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 079201386
Report Date: 11/19/2024
Date Signed: 11/19/2024 12:25:44 PM

Document Has Been Signed on 11/19/2024 12:25 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
OAKLAND ASC, 1515 CLAY STREET, STE. 310
OAKLAND, CA 94612
FACILITY NAME:CORAL HOME CARE LLCFACILITY NUMBER:
079201386
ADMINISTRATOR/
DIRECTOR:		REYES, LOUISFACILITY TYPE:
740
ADDRESS:180 CORAL BELL WAYTELEPHONE:
(925) 306-9304
CITY:OAKLEYSTATE: CAZIP CODE:
94561
CAPACITY: 6CENSUS: 1DATE:
11/19/2024
TYPE OF VISIT:Post LicensingUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:43 AM
MET WITH:Ivette Reyes, LicenseeTIME VISIT/
INSPECTION COMPLETED:
12:55 PM
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On 11/19/2024 at 10:43 AM, Licensing Program Analyst (LPA) T.Syess-Gibson conducted an unannounced Post Licensing inspection and met with Licensee, Ivette Reyes. LPA explained the purpose of the visit with Licensee. LPA observed one female resident in the living room watching TV.

At 11:03AM, LPA inspected including, but not limited to, living room, kitchen, dining area, bathrooms, bedrooms, laundry area, activity room and outside areas. There were no bodies of water present at the facility. The facility has four (4) bedrooms and three (3) bathrooms. Ample supply of toiletries and linens are available. Sufficient lighting and furniture throughout facility. 2 day perishable and 7 day non perishable food supply are available. Facility's inside temperature is maintained at 70 degrees, F.

At 11:27AM, Hot water temperature in resident's bathroom was measured at 99.8 degrees, F. Licensee informed LPA of just finished laundry. Medications, toxins and sharps observed stored locked and inaccessible to residents in care. Fire extinguisher, smoke and carbon monoxide detectors were observed operational. Emergency Disaster Plan dated 09/19/24 was posted and required posters centrally posted.

At 12:15AM LPA reviewed resident file which was complete.

Exits and passageways are free of obstruction. No Fire drill has been conducted as of today. Staff present has current first aid certificates and are fingerprint cleared.

No deficiencies cited during visit.

Exit interview conducted and a copy of this report provided.
SUPERVISORS NAME: Harpreet Humpal
LICENSING EVALUATOR NAME: Tonica Syess-Gibson
LICENSING EVALUATOR SIGNATURE: DATE: 11/19/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/19/2024
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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