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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 079200932
Report Date: 11/27/2023
Date Signed: 11/27/2023 04:36:36 PM


Document Has Been Signed on 11/27/2023 04:36 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
OAKLAND ASC, 1515 CLAY STREET, STE. 310
OAKLAND, CA 94612



FACILITY NAME:MEGAN CARE HOMEFACILITY NUMBER:
079200932
ADMINISTRATOR:CHAUDHRY, TAYYABAFACILITY TYPE:
740
ADDRESS:118 MEGAN CTTELEPHONE:
(925) 433-6000
CITY:ALAMOSTATE: CAZIP CODE:
94507
CAPACITY:6CENSUS: 4DATE:
11/27/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
03:10 PM
MET WITH:Tayyaba Chaudhry, AministratorTIME COMPLETED:
04:45 PM
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At 3:10PM Licensing Program Analyst (LPA) A. Gomez and Licensing Program Manager Y. Flores-Larios arrived unanounced to conduct a 1-Year Annual Required visit and met with Care taker, Melaine Rona. Administrator Tayyaba Chaudhry arrived at 3:25PM.

LPAs toured and inspected the facility inside and outside with staff including but not limited to bedrooms, bathrooms, kitchen, common area and backyard. The facility consists of seven (7) total bedrooms which Four (4) bedrooms are occupied by the residents and One (1) bedroom is occupied by staff. All outdoor and indoor passageways are kept free of obstruction. There were no bodies of water present at this facility. LPA observed medication to be locked. LPA observed lighting in all rooms are adequate for the comfort and safety of the clients. Hot water temperature in the residents’ shared bathroom was measured at 109.3 degrees F. Resident's bathrooms have grab bars inside the shower and next to the shower. The shower has a non-skid mat. Hygiene items, extra linens and toiletry supplies were checked and sufficient. Fire extinguisher in kitchen was last serviced on 3/27/2023, smoke detectors and carbon monoxide were operational. First aid kit was inspected and was incomplete. Food supplies were sufficient to meet 2-day perishable and 7-day non-perishable requirements. LPA observed a sample of medication.

continued on LIC809-C
SUPERVISOR'S NAME: Yvonne Flores-LariosTELEPHONE: (510) -28-0517
LICENSING EVALUATOR NAME: Alona GomezTELEPHONE: 510-239-1306
LICENSING EVALUATOR SIGNATURE:
DATE: 11/27/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/27/2023
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
OAKLAND ASC, 1515 CLAY STREET, STE. 310
OAKLAND, CA 94612
FACILITY NAME: MEGAN CARE HOME
FACILITY NUMBER: 079200932
VISIT DATE: 11/27/2023
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Resident records were reviewed at approximately 3:40pm. Staff records were reviewed at approximately 3:50PM.


Updated copies of the following documents were requested for facility file and are to be submitted to CCL by 12/04/2023:

LIC 500 Personnel Report
LIC 610E Emergency Disaster Plan
Liability Insurance
Updated facility sketch

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: 11/27/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/27/2023
LIC809 (FAS) - (06/04)
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