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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 071440596
Report Date: 11/30/2023
Date Signed: 11/30/2023 10:10:01 AM


Document Has Been Signed on 11/30/2023 10:10 AM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
OAKLAND ASC, 1515 CLAY STREET, STE. 310
OAKLAND, CA 94612



FACILITY NAME:ROUNDHILL CARE HOMES, INC.FACILITY NUMBER:
071440596
ADMINISTRATOR:PEDRO D. ZAMORAFACILITY TYPE:
740
ADDRESS:3053 ROUNDHILL ROADTELEPHONE:
(925) 837-0599
CITY:ALAMOSTATE: CAZIP CODE:
94507
CAPACITY:6CENSUS: 2DATE:
11/30/2023
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Ana Breen, AdministratorTIME COMPLETED:
10:30 AM
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On 11/30/2023 at 9:30am, Licensing Program Analysts (LPAs) A. Gomez and L. Hall arrived unannounced to conduct proof of correction (POC) visit. LPAs met with Ana Breen, Administrator, and explained the purpose of the visit.

LPA A Gomez conducted a POC visit on 11/03/2023 and cited facility for the following:

· 87303(a) Care Persons with Dementia- LPAs observed today swimming pool fenced and locked

· 87555(b)(8) General Food Service Requirements- LPAs observed today food of good quality and labeled appropriately.

· 87303(a) Maintenance and Operation- LPAs observed the facility to be clean and in good repair

· 87307(d)(6) Personal Accommodations and Services- LPAs observed the facility and yard to be free of obstruction

LPAs observed that all deficiencies are now clear.

Exit interview conducted and a copy of this report provided

SUPERVISOR'S NAME: Yvonne Flores-LariosTELEPHONE: (510) -28-0517
LICENSING EVALUATOR NAME: Alona GomezTELEPHONE: 510-239-1306
LICENSING EVALUATOR SIGNATURE:
DATE: 11/30/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/30/2023
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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