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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 079200940
Report Date: 02/15/2024
Date Signed: 02/15/2024 04:55:44 PM


Document Has Been Signed on 02/15/2024 04:55 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:NEW ALAMO RESIDENCE HOMEFACILITY NUMBER:
079200940
ADMINISTRATOR:SAXENA, MEERANFACILITY TYPE:
740
ADDRESS:836 STONE VALLEY RDTELEPHONE:
(925) 743-1565
CITY:ALAMOSTATE: CAZIP CODE:
94507
CAPACITY:6CENSUS: 6DATE:
02/15/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
02:30 PM
MET WITH:Administrator, Meeran SaxenaTIME COMPLETED:
05:00 PM
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On 2/15/2024 at 3:00 PM, Licensing Program Analysts (LPA) A. Gomez arrived unannounced to conduct 1-Year Annual Required inspection. LPA met with Administrator, Meeran Saxena and explained the purpose of the visit. The facility’s fire clearance was approved for five (5) non-ambulatory and one (1) bedridden residents. There are 6 residents and 2 staff present during inspection.

LPA toured facility with Administrator including but not limited to bedrooms, bathrooms, kitchen, common area and backyard. The facility consists of 8 total bedrooms which 6 bedrooms are occupied by the residents and 2 bedrooms are 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 70 degrees Fahrenheit. LPA observed lighting in all rooms are adequate for the comfort and safety of the residents. Residents’ 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. Hot water temperature measured at Degrees Fahrenheit.

Smoke detectors and carbon monoxide detector were in operating condition during visit. Fire extinguisher was serviced on 3/17/2023. Emergency Disaster Plan was last updated on 3/23/2023. First aid kit was observed to be complete. Fire drill was last done 12/18/2023

At 3:30 PM, LPA reviewed 3 staff records and 2 of 3 have current first aid training and at least 1 staff have CPR training per shift.


REPORT CONTINUES 809C
SUPERVISOR'S NAME: Yvonne Flores-LariosTELEPHONE: (510) -28-0517
LICENSING EVALUATOR NAME: Alona GomezTELEPHONE: 510-239-1306
LICENSING EVALUATOR SIGNATURE:
DATE: 02/15/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/15/2024
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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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: NEW ALAMO RESIDENCE HOME
FACILITY NUMBER: 079200940
VISIT DATE: 02/15/2024
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Updated copies of the following documents were requested for facility file and are to be submitted to CCL by 2/29/2024

LIC 308 Designation of Administrative Responsibility
LIC 309 Administrative Organization
LIC 500 Personnel Report
LIC 610E Emergency Disaster Plan
Liability Insurance
Current Administrator’s Certificate

No Deficiencies cited during visit

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: 02/15/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/15/2024
LIC809 (FAS) - (06/04)
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