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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 079200594
Report Date: 12/12/2024
Date Signed: 12/12/2024 01:04:53 PM

Document Has Been Signed on 12/12/2024 01:04 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:ELWYN CALIFORNIA - CAMINO SOLANOFACILITY NUMBER:
079200594
ADMINISTRATOR/
DIRECTOR:		ANGEL, LOURDES DFACILITY TYPE:
734
ADDRESS:1194 CAMINO SOLANOTELEPHONE:
(408) 558-1500
CITY:CONCORDSTATE: CAZIP CODE:
94521
CAPACITY: 4TOTAL ENROLLED CHILDREN: 0CENSUS: 4DATE:
12/12/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:30 AM
MET WITH:Lourdes Angel, AdministratorTIME VISIT/
INSPECTION COMPLETED:
01:15 PM
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On 12/12/24, Licensing Program Analyst (LPA) Greg Clark arrived unannounced to conduct 1-Year Annual Required inspection. LPA met with Administrator, Lourdes Angel and explained the purpose of the visit.

LPA toured the facility including but not limited to bedrooms, bathrooms, kitchen, common area and backyard. All outdoor and indoor passageways are kept free of obstruction. There are no bodies of water. A comfortable temperature for clients is maintained at 70-degree Fahrenheit. LPA observed lighting in all rooms are adequate for the comfort and safety of the clients. Hot water temperature in the shared clients’ bathroom was measured at 105.5 degrees Fahrenheit. All toilets, hand washing, and bathing are safe, sanitary and in operating condition. The supply of extra hygiene was available for clients. There is a minimum of one-week supply of non-perishables and 2-day perishables food supply.

Smoke detectors, fire extinguisher and carbon monoxide were in operating condition during visit. Emergency Disaster Plan was last posted on 12/12/24. First aid kit was observed to be complete. Fire drill was last conducted on 12/12/24 on the NOC shift.

LPA reviewed 4 clients’ records and 4 staff records, and all were complete. A sample of 2 client’s medications were reviewed.

No deficiencies were cited during this inspection. Exit interview conducted and a copy of this report provided.
Yvonne Flores-LariosTELEPHONE: (510) 286-0517
Gregory ClarkTELEPHONE: 510-285-3927
DATE: 12/12/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/12/2024
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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