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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 015601428
Report Date: 01/07/2025
Date Signed: 01/07/2025 05:11:16 PM

Document Has Been Signed on 01/07/2025 05:11 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 NEW HAVEN CARE HOME - HAMPTONFACILITY NUMBER:
015601428
ADMINISTRATOR/
DIRECTOR:		SOLETA, ARNOLD B.FACILITY TYPE:
740
ADDRESS:1356 HAMPTON PLACETELEPHONE:
(925) 292-4065
CITY:LIVERMORESTATE: CAZIP CODE:
94550
CAPACITY: 6TOTAL ENROLLED CHILDREN: 0CENSUS: 6DATE:
01/07/2025
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
02:40 PM
MET WITH:Nenita Manuel, CaregiverTIME VISIT/
INSPECTION COMPLETED:
05:25 PM
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On 1/7/2025 at 2:40PM, Licensing Program Analyst (LPA) G. Luk arrived unannounced to conduct a Required - 1 Year inspection. LPA met with Caregiver, Nenita Manuel and explained the purpose of the visit.


LPA toured the facility including but not limited to bedrooms, bathrooms, dining area, kitchen, garage, and outdoor area. Smoke and carbon monoxide detectors were observed. Fire extinguisher was observed to be full and last serviced on 2/2/2024. One week of nonperishable and 2-day of perishable food supplies were available. Hot water temperature was measured at 109.6 degrees F in the hallway bathroom. LPA observed grab bars and non-skid mat in the bathrooms. There were adequate lights in each room. Resident rooms were observed to be cleaned and fully furnished. First Aid kit is complete. Last disaster drill was conducted on 12/8/2024. Indoor and outdoor passages were free of obstruction. No bodies of water observed.


LPA reviewed 3 residents and 3 staff files starting at 3:25PM. Residents' files were complete with admission agreement, medical assessment, care plan, and emergency information. Staff are fingerprint cleared and associated to the facility. LPA reviewed a sample of resident's medications during inspection.


No deficiencies are being cited on this date.


Exit interview conducted. A copy of this report was provided.
Harpreet HumpalTELEPHONE: (510) 285-3928
Grace LukTELEPHONE: (510) 286-4201
DATE: 01/07/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/07/2025
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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