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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 079201391
Report Date: 09/17/2024
Date Signed: 09/17/2024 02:32:42 PM

Document Has Been Signed on 09/17/2024 02:32 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:ANCHOR ELDERLY CARE HOMEFACILITY NUMBER:
079201391
ADMINISTRATOR/
DIRECTOR:		MORALES-ALTOBAR, MAEFACILITY TYPE:
740
ADDRESS:2268 HIGHLANDS ROADTELEPHONE:
(510) 724-3248
CITY:SAN PABLOSTATE: CAZIP CODE:
94806
CAPACITY: 5CENSUS: 4DATE:
09/17/2024
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:50 AM
MET WITH:FELINOR MARIANO, ADM (FELY-MAR)TIME VISIT/
INSPECTION COMPLETED:
12:25 PM
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On 9/17/2024 at 9:50am, Licensing Program Analyst (LPA) Carol Fowler conducted an unannounced pre-licensing. LPA met with Felinor Mariano, Administrator for Fely-Mar (Administrator Mae Morales-Altobar was not available during visit) and explained the purpose of the visit. The facility has an approved fire safety clearance for five (5) non-ambulatory residents.

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 seven (7) bedrooms and three (3) bathrooms four (4) bedrooms and one (1) bathroom is occupied by staff. No bodies of water observed. There is sufficient lighting around the facility. Clients rooms are equipped with the proper furniture, and lighting. Bathrooms showers/tubs were equipped with non skid mats. Locked cabinets available to store medications, toxins and sharps. Hot water temperature is measured at 108.5 degrees Fahrenheit in shared clients' bathroom. Carbon monoxide and smoke detectors present and operable. Facility inspection matches the sketch that was provided.

Facility needs to correct the following before being licensed:

· Lock for chemicals and laundry detergent in garage.
· Lock Caregivers rooms which contained unlocked medication.
· Provide flat and fitted sheets for residents beds.
· Lock toolbox which contains tools located in garage.
· Remove medication (B12, multi vitamins and RX drugs) in drawer located in covered area.

Continued on LIC809C.
SUPERVISORS NAME: Bennett Fong
LICENSING EVALUATOR NAME: Carol Fowler
LICENSING EVALUATOR SIGNATURE: DATE: 09/17/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/17/2024
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: ANCHOR ELDERLY CARE HOME
FACILITY NUMBER: 079201391
VISIT DATE: 09/17/2024
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continue from LIC 809
  • Remove 4X4 wood planks buckets pole, ladders dolly, cooking pots, located in the backyard.
  • Remove all clutter such as boxes of shoes, tools, baskets, mattress, suitcase, shovel and other items stacked in covered porch area.
  • Purchase a better lock for outside shed.
  • Residents files are incomplete.
  • Staff files not available.



Issues were noted during inspection. LPA observed that facility is not ready to be licensed. This report will be submitted to the Central Applications 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 with Licensee and a copy of this report provided.
SUPERVISORS NAME: Bennett Fong
LICENSING EVALUATOR NAME: Carol Fowler
LICENSING EVALUATOR SIGNATURE:

DATE: 09/17/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/17/2024
LIC809 (FAS) - (06/04)
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