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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 079201205
Report Date: 09/25/2023
Date Signed: 09/25/2023 03:54:52 PM


Document Has Been Signed on 09/25/2023 03:54 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:LOVING HANDSFACILITY NUMBER:
079201205
ADMINISTRATOR:MORALES, MA MERCEDES R.FACILITY TYPE:
740
ADDRESS:2621 PRESIDIO DRTELEPHONE:
(925) 330-5129
CITY:BRENTWOODSTATE: CAZIP CODE:
94513
CAPACITY:5CENSUS: 5DATE:
09/25/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Mercedes MoralesTIME COMPLETED:
04:15 PM
NARRATIVE
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On 09/25/2023 at 9:30 AM, Licensing Program Analyst (LPA) J. Sampair arrived unannounced at facility for the required annual inspection. Upon entering facility, LPA stated purpose of visit to staff member Lilibeth Padrid who called Licensee Mercedes Morales. The Licensee arrived at approximately 11:45 AM.

During the Inspection, the LPA inspected the facility inside and outside. LPA reviewed 4 staff and 5 resident files and interviewed 2 residents and 2 staff. LPA observed that the facility has a sufficient supply of food: 2 days perishable and 7 days nonperishable. A comfortable inside temperature of 72.5 degrees F was maintained. The facility was clean and the staff attentive to residents' needs.

2 Type-B citations were issued during the inspection (details in LIC809-D).

Exit interview conducted with Licensee and a copy of this report was provided via email.
SUPERVISOR'S NAME: Bennett FongTELEPHONE: (510) -62-2621
LICENSING EVALUATOR NAME: James SampairTELEPHONE: (510) 286-4201
LICENSING EVALUATOR SIGNATURE:
DATE: 09/25/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/25/2023
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


Document Has Been Signed on 09/25/2023 03:54 PM - It Cannot Be Edited

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: LOVING HANDS
FACILITY NUMBER: 079201205

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/25/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
87303(e)(4)
Maintenance and Operation
(e) Water supplies and plumbing fixtures shall be maintained as follows: (4) Grab bars shall be maintained for each toilet, bathtub and shower used by residents.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, the licensee did not comply with the section cited above in 2 out of 3 bathrooms, which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 10/02/2023
Plan of Correction
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On or before the due date, the Licensee shall install grab bars in the 2 bathrooms where there is no grab bar for the toilet.
Type B
Section Cited
CCR
87305(a)
87305 Alterations to Existing Building or New Facilities (a) Prior to construction or alterations, all facilities shall obtain a building permit.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, the licensee did not comply with the section cited above in the staff room, which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 10/02/2023
Plan of Correction
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On or before the due date, the Licensee shall inform the LPA of the plan for a wall to be installed with a permit from the Brentwood Planning Department along with a date by when the wall will be installed. If it will not be allowed by the Brentwood City Planning Department, then the wall must be removed.
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME: Bennett FongTELEPHONE: (510) -62-2621
LICENSING EVALUATOR NAME: James SampairTELEPHONE: (510) 286-4201
LICENSING EVALUATOR SIGNATURE:
DATE: 09/25/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/25/2023
LIC809 (FAS) - (06/04)
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