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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 075601509
Report Date: 03/27/2024
Date Signed: 03/27/2024 03:56:07 PM


Document Has Been Signed on 03/27/2024 03:56 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, 1515 CLAY STREET, STE. 310
OAKLAND, CA 94612



FACILITY NAME:MORAGA RETREAT CARE ON WOODFORDFACILITY NUMBER:
075601509
ADMINISTRATOR:BLAJ, ANAMARIAFACILITY TYPE:
740
ADDRESS:3 WOODFORD DRIVETELEPHONE:
(925) 376-2273
CITY:MORAGASTATE: CAZIP CODE:
94556
CAPACITY:6CENSUS: 5DATE:
03/27/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
02:00 PM
MET WITH:Anamaria BlaJ, AdminstratorTIME COMPLETED:
04:20 PM
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On today date, Licensing Program Analyst (LPAs) K. Nguyen and L. Holmes arrived unannounced to conduct 1-Year Annual Required inspection. LPAs met with facility Anamaria Blah, administrator, and explained the purpose of the visit.

LPAs toured facility with including but not limited to bedrooms, bathrooms, kitchen, common area and backyard. The facility consists of 7 total bedrooms which 6 bedrooms are occupied by the residents and 1 bedroom is occupied by staff. All outdoor and indoor passageways are kept free of obstruction. There are no bodies of water observed. A comfortable temperature is maintained at 71 degrees Fahrenheit. LPAs observed lighting in all rooms are adequate for the comfort and safety of the clients. The hot water temperature in the clients’ shared bathroom was measured at 118.2 degrees Fahrenheit. Clients’ bathrooms are equipped with grab bars and non-skid mats. There is a minimum of one week supply of nonperishable and 2-day of perishable foods. Centrally stored medication and sharps were locked and inaccessible to residents.

Smoke detectors and carbon monoxide detectors were in operating condition during visit. Fire extinguisher was last serviced on 5/53/2023. Emergency Disaster Plan was last posted on 1/23/2024. First aid kit was observed to be complete.

LPAs reviewed 4 residents records. LPAs reviewed 2 staff records and 2 of 2 have current first aid training and associated to the facility. LPAs reviewed a sample of resident’s medications.

No deficiencies cited during visit. Exit interview conducted and a copy of this report provided via email.

SUPERVISOR'S NAME: Bennett FongTELEPHONE: (510) 725-7919
LICENSING EVALUATOR NAME: Kelly NguyenTELEPHONE: (510) 915-8702
LICENSING EVALUATOR SIGNATURE:
DATE: 03/27/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/27/2024
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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