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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 079200347
Report Date: 08/10/2022
Date Signed: 08/10/2022 01:05:01 PM


Document Has Been Signed on 08/10/2022 01:05 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:DANVILLE PARADISEFACILITY NUMBER:
079200347
ADMINISTRATOR:PAMELA PLASCENCIAFACILITY TYPE:
740
ADDRESS:1207 GREENBROOK DRIVETELEPHONE:
(925) 838-2831
CITY:DANVILLESTATE: CAZIP CODE:
94526
CAPACITY:6CENSUS: 5DATE:
08/10/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
12:26 PM
MET WITH:Pamela Chan, AdministratorTIME COMPLETED:
01:15 PM
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On 8/10/2022 at 12:26 PM, Licensing Program Analysts (LPAs) L. Francisco and P. Watson arrived unannounced to conduct Infection Control Inspection. Upon arrival, LPAs were greeted by Care Staff, Arlene Dela Paz. Administrator, Pamela Chan later arrived at 12:30 PM

During the Infection Control Inspection, LPAs toured facility with Care Staff and Administrator including but not limited to front entrance, screening station, hand washing stations, bedrooms, common areas, kitchen and backyard. Facility has a sufficient 2-day perishable and one week non-perishable food supply. Visitors policy is posted on the front entrance. There is one central entry point for universal screening for staff, residents and visitors. A sign-in policy, thermometer and hand sanitizer were observed at screening station. Cough/sneeze etiquette, social distancing and hand washing posters were observed. Common touched surfaces are disinfected at least once daily. Bathrooms are equipped with liquid soap, paper towel and trash bin with touchless lids. Facility staff were observed to be wearing proper PPE. PPEs maintained at central location and easily accessible for staff.

At 12:50 PM, LPAs reviewed 3 staff records and 3 of 3 have health screening and TB test results on file. Facility has a mitigation plan and maintains record of routine screening for residents and staff.

No deficiency cited during visit. Exit interview conducted with Administrator and a copy of report provided.
SUPERVISOR'S NAME: Harpreet HumpalTELEPHONE: (510) 285-3928
LICENSING EVALUATOR NAME: Lizette FranciscoTELEPHONE: (510) 286-4201
LICENSING EVALUATOR SIGNATURE:
DATE: 08/10/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/10/2022
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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