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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 486804109
Report Date: 04/11/2023
Date Signed: 04/11/2023 04:08:42 PM

Document Has Been Signed on 04/11/2023 04:08 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, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405
FACILITY NAME:ALL QUALITY HOME CARE SERVICES, LLCFACILITY NUMBER:
486804109
ADMINISTRATOR:CARO, MARVINFACILITY TYPE:
735
ADDRESS:170 TERI CTTELEPHONE:
(510) 230-9897
CITY:VALLEJOSTATE: CAZIP CODE:
94589
CAPACITY: 4CENSUS: 0DATE:
04/11/2023
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
02:00 PM
MET WITH:Marvin Caro, ApplicantTIME COMPLETED:
04:20 PM
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Licensing Program Analyst (LPA) Karina Canela arrived for the purpose of conducting a pre-licensing inspection on 04/11/2023.
LPA met with applicant Marvin Caro, Applicant, who will be the Administrator once the facility is approved for licensure. The facility has a fire clearance approval from the American Canyon Fire Department for a total capacity of 4 ambulatory clients only. Facility will operate with 24 hour staffing and Licensee will ensure sufficient staffing at all times.

During today’s visit LPA observed the following items:
· Lockable separate cabinets for medications, toxins/cleaners, and knives.
· All exits were unobstructed, · 1 charged Fire Extinguisher
· 6 hardwired smoke detectors and 1 carbon monoxide detector, were tested and observed operational
· Complete first Aid kit, night-lights, and flashlights for emergency lighting
· Supply of linens (bedsheets), paper products, and hygiene supplies available
· Required furnishings in 4 of 4 bedrooms

The Component III Orientation was completed.

Pre-licensing is complete with no corrections needed.

LPA will submit the pre-licensing application report to the Application Unit Analyst in Sacramento; Application Unit Analyst will notify applicant of application status.

No deficiencies cited

SUPERVISORS NAME: Hope DeBenedetti
LICENSING EVALUATOR NAME: Karina Canela
LICENSING EVALUATOR SIGNATURE: DATE: 04/11/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/11/2023
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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