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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 015600722
Report Date: 12/06/2024
Date Signed: 12/06/2024 12:43:21 PM

Document Has Been Signed on 12/06/2024 12:43 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:A HOME OF OUR OWN IIFACILITY NUMBER:
015600722
ADMINISTRATOR/
DIRECTOR:
FEKETE, EMILYFACILITY TYPE:
740
ADDRESS:2162 HAMPTON ROADTELEPHONE:
(925) 292-4848
CITY:LIVERMORESTATE: CAZIP CODE:
94550
CAPACITY: 2TOTAL ENROLLED CHILDREN: 0CENSUS: 0DATE:
12/06/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:30 AM
MET WITH:Emily Fekete, AdministratorTIME VISIT/
INSPECTION COMPLETED:
01:00 PM
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On 11/19/2024 at 2:45PM, LPA G. Luk had an attempted visit for an annual inspection. LPA was unable to conduct the inspection on this date.

On 12/6/2024 at 10:30AM, Licensing Program Analyst (LPA) G. Luk arrived unannounced to conduct a Required - 1 Year inspection. LPA met with Administrator/Licensee, Emily Fekete and explained the purpose of the visit. The facility’s fire clearance was approved for 2 non-ambulatory residents.

LPA was informed facility had no residents. LPA toured facility including but not limited to bedroom, bathrooms, kitchen, common areas, garage, and outdoor area. Smoke and carbon monoxide detectors were observed. Fire extinguisher was observed to be full and last serviced on 10/14/2024. Facility has some nonperishable and perishable foods available. Licensee will obtain additional food prior to admitting residents. LPA observed grab bars and non-skid mat in the bathroom. Hot water was measured at 120 degrees F in the hallway bathroom. First Aid kit is complete. The facility has a written emergency disaster plan. LPA reviewed administrator's file.

Facility has a pool without a fence. Licensee understands that a 5 ft fence or covering will be put up prior to admitting residents.

No deficiencies are being cited on this date.

Exit interview conducted. A copy of this report provided.
Harpreet HumpalTELEPHONE: (510) 285-3928
Grace LukTELEPHONE: (510) 286-4201
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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