<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 079201127
Report Date: 01/04/2024
Date Signed: 01/04/2024 04:16:09 PM


Document Has Been Signed on 01/04/2024 04:16 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:ALAMO RESIDENCE HOMEFACILITY NUMBER:
079201127
ADMINISTRATOR:ENRIQUEZ, JOY MANALANGFACILITY TYPE:
740
ADDRESS:2978 MIRANDA AVETELEPHONE:
(408) 449-8044
CITY:ALAMOSTATE: CAZIP CODE:
94507
CAPACITY:6CENSUS: 5DATE:
01/04/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
12:44 PM
MET WITH:Care Staff, Jhon Marie WoffendenTIME COMPLETED:
04:35 PM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
On 1/04/2024 at 12:15 PM, Licensing Program Analyst (LPA) A. Gomez arrived unannounced to conduct the required 1-year annual inspection. LPA was greeted by Care Staff, Jhon Marie Woffenden. Administrator, Joy Manalang later arrived at 1:20 PM. Facility is approved for all may be non-ambulatory residents.

LPA toured facility including but not limited to residents bedrooms, caregiver bedrooms, bathrooms, kitchen, common areas and backyard. 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 F. LPA observed lighting in all rooms are adequate for the comfort and safety of the residents. The hot water temperature in the residents’ shared bathroom was measured at 114.8 degrees F. 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.

LPA observed carbon monoxide and smoke detectors during visit. Fire extinguisher was last purchased on 1/4/2024. Emergency Disaster Plan was last posted on 1/4/2024. First aid kit was observed to be complete.
disaster drill was last conducted on 10/14/2023 .

LPA reviewed 4 staff records and 4 of 4 are associated. LPA reviewed 4 residents records.


Report continues on LIC809-C
SUPERVISOR'S NAME: Yvonne Flores-LariosTELEPHONE: (510) -28-0517
LICENSING EVALUATOR NAME: Alona GomezTELEPHONE: 510-239-1306
LICENSING EVALUATOR SIGNATURE:
DATE: 01/04/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/04/2024
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


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: ALAMO RESIDENCE HOME
FACILITY NUMBER: 079201127
VISIT DATE: 01/04/2024
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
Updated copies of the following documents were requested for facility file and are to be submitted to CCLD by 1/19/2024:

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 with Administrator 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: 01/04/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/04/2024
LIC809 (FAS) - (06/04)
Page: 2 of 2