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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 075601062
Report Date: 07/06/2023
Date Signed: 07/06/2023 07:28:53 PM


Document Has Been Signed on 07/06/2023 07:28 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
E BAY DELTA AC/SC, 1515 CLAY STREET, STE. 310
OAKLAND, CA 94612



FACILITY NAME:BETTER LIVING CARE HOMEFACILITY NUMBER:
075601062
ADMINISTRATOR:GALERA, ANABELLE & RUDOLPHFACILITY TYPE:
740
ADDRESS:106 VIVIAN DRIVETELEPHONE:
(925) 674-8820
CITY:PLEASANT HILLSTATE: CAZIP CODE:
94523
CAPACITY:8CENSUS: 8DATE:
07/06/2023
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
06:30 PM
MET WITH:Liza Sanchez, CaregiverTIME COMPLETED:
07:30 PM
NARRATIVE
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On 07/06/2023 Licensing Program Analyst (LPA) L. Alexander conducted a Case Management visit as a result of an file review of resident records during a complaint visit.

The following Title 22 deficiencies are being cited as a result of the visit today.

Please see the 809-D for details of the deficiencies.


Exit interview conducted. Appeal Rights and a copy of this report provided.
SUPERVISOR'S NAME: Bennett FongTELEPHONE: (510) 725-7919
LICENSING EVALUATOR NAME: Lori Alexander-WashingtonTELEPHONE: (510) 285-3934
LICENSING EVALUATOR SIGNATURE:
DATE: 07/06/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/06/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 2


Document Has Been Signed on 07/06/2023 07:28 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
E BAY DELTA AC/SC, 1515 CLAY STREET, STE. 310
OAKLAND, CA 94612


FACILITY NAME: BETTER LIVING CARE HOME
FACILITY NUMBER: 075601062

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/06/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
07/11/2023
Section Cited
CCR
87506(d)(e)

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87506 Resident Records..(d) All resident records be available to the licensing agency,,upon demand during normal business hours.
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Administrators will send copies of Physicians Reports, Admission Agreements, Pre-placement Appraisals, Progress Notes, Hospitalizations, Dr's Orders, Medications, Staff Schedules to CCL
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(e) Original records or...shall be retained for a minimum of three (3) years...
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CCR

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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME: Bennett FongTELEPHONE: (510) 725-7919
LICENSING EVALUATOR NAME: Lori Alexander-WashingtonTELEPHONE: (510) 285-3934
LICENSING EVALUATOR SIGNATURE:
DATE: 07/06/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/06/2023
LIC809 (FAS) - (06/04)
Page: 2 of 2