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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 385600181
Report Date: 05/27/2021
Date Signed: 05/27/2021 11:32:18 AM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
FACILITY NAME:MERCED TWO RESIDENTIAL CARE FACILITYFACILITY NUMBER:
385600181
ADMINISTRATOR:JOYCE LEEFACILITY TYPE:
740
ADDRESS:257 BROAD STREETTELEPHONE:
(415) 585-6112
CITY:SAN FRANCISCOSTATE: CAZIP CODE:
94112
CAPACITY:14CENSUS: 14DATE:
05/27/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:20 AM
MET WITH:Luong Ly (Jack) and Tommy LeeTIME COMPLETED:
11:40 AM
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On 05/27/21, Licensing Program Analyst (LPA), Mohamed Filouane, conducted an unannounced 1-year required inspection. At 10:30 AM, LPA met with Administrator Luong Ly at the entrance of the facility and announced the 1-year required inspection. LPA underwent a health screening following the facility's entrance safety procedures. LPA also had his temperature checked and logged and then signed into the facility. Licensee Tommy Lee arrived at the facility shortly after.

At 10:40 AM, LPA toured the physical plant. The physical plant is consistent with the submitted facility sketch/floor plan and has the COVID-19 health and safety signage. There are no obstructions blocking indoor and outdoor passageways. The kitchen is sanitary and organized. The facility uses the connected facility's kitchen to prepare meals. At approximately 10:55 AM, LPA observed the refrigerator and freezer was stocked with fruits, vegetables, meat, eggs, and bottled water. LPA observed the facility's emergency food supply as sufficient.

The clients' bedrooms were inspected and all had required lighting and furniture. Facility is equipped with smoke detectors and carbon monoxide detectors. LPA also observed the fire extinguishers as current. The facility's first aid kit included the required tweezers, scissors, and a thermometer. During the facility tour, LPA observed the bathrooms are clean and sanitary. The facility bathrooms had the required hand washing signage. LPA advised to include additional handwashing signage at the facility's sanitation stations. Cleaning solutions are stored and locked. PPE is stocked and current.

At 11:00 AM, LPA completed the facility tour for Infection Control. This report was reviewed with the Administrator and the Licensee. No deficiencies were cited today.

Exit interview conducted with the Administrator. Due to technical difficulties, a copy of this report will be emailed to the Administrator.
SUPERVISOR'S NAME: Julio MontesTELEPHONE: (650) 272-7906
LICENSING EVALUATOR NAME: Mohamed FilouaneTELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:

DATE: 05/27/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/27/2021
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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