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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 486804109
Report Date: 05/01/2024
Date Signed: 05/01/2024 02:13:40 PM

Document Has Been Signed on 05/01/2024 02:13 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/
DIRECTOR:		CARO, MARVINFACILITY TYPE:
735
ADDRESS:170 TERI CTTELEPHONE:
(510) 230-9897
CITY:VALLEJOSTATE: CAZIP CODE:
94589
CAPACITY: 4CENSUS: 0DATE:
05/01/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
11:45 AM
MET WITH:Marvin CaroTIME VISIT/
INSPECTION COMPLETED:
01:50 PM
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Licensing Program Analyst (LPA) Araceli Canela conducted an announced Annual Required – 1 yr. inspection. LPA had previously attempted a visit but no one was home. Facility informed LPA, they had no clients at this time and this visit was scheduled due to no clients at this facility. LPA met with Administrator, Marvin Caro.

Facility was at a comfortable temperature with all exits free from obstruction. Client’s bedrooms, common areas, kitchen & food storage were inspected.
All bedrooms have the required furnishing, but have no personal belongings as they have no clients. Fire Extinguisher was found charged but requires proof of service and administrator stated they will be replacing it before any clients move in. Smoke and carbon monoxide detectors were operational. Facility understands that on the first day of any clients moving in, there has to be a sufficient supply of non-perishable foods as required by Title 22 Regulations. Administrator plans to replenish perishable food supply once clients are admitted to the facility. Sharps will be locked in the garage. Water at faucets accessible to clients are within Title 22 Regulations between 105 and 120 degrees F. LPA found that staff have current CPR and 1st Aid certification that expires 9/9/2024. Toxins will be stored in a locked garage or locked under sink.
LPA requested the following documents be sent to CCL by COB 6/1/2024:

LIC 308 Designated Facility Responsibility
LIC 500 Personnel Summary
LIC 610 Emergency Disaster Plan
Copy of Administrator Certificate(s)

No deficiencies cited during today's visit.
SUPERVISORS NAME: Kimberley Mota
LICENSING EVALUATOR NAME: Araceli Canela
LICENSING EVALUATOR SIGNATURE: DATE: 05/01/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/01/2024
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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