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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 011441162
Report Date: 12/30/2024
Date Signed: 12/30/2024 02:13:56 PM

Document Has Been Signed on 12/30/2024 02:13 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:GALICIA'S TULIP CARE HOME #2FACILITY NUMBER:
011441162
ADMINISTRATOR/
DIRECTOR:
GALICIA, CONSUELOFACILITY TYPE:
740
ADDRESS:745 CINNAMON COURTTELEPHONE:
(510) 783-4888
CITY:HAYWARDSTATE: CAZIP CODE:
94544
CAPACITY: 6CENSUS: 6DATE:
12/30/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:00 AM
MET WITH:Consuelo Galicia, Administrator TIME VISIT/
INSPECTION COMPLETED:
02:45 PM
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On this day, December 30, 2024, Licensing Program Analyst (LPA) K. Nguyen arrived unannounced to conduct an annual required inspection. LPA met with staff, Ruth Carreon, Perlita Peria and Nimfa Boado, and informed the reason for visit. LPA called and spoke over the phone with Consuelo 'Connie' Galicia, licensee-administrator, who authorized Ruth Carreon to be with LPA in touring the facility. Administrator, Connie, arrived at 12:10 p.m.

LPA toured the facility inside out with Ruth Carreon. LPA inspected the kitchen, dining area, staff quarter/office, bedrooms, bathrooms, front and backyards. Food supplies were observed good for 2 days of perishables and 7 days of non-perishables.

Facility has smoke and carbon monoxide detectors that were tested and observed functional. Hot water temperature in one of the bathrooms was tested and measured at 105.4 degrees Fahrenheit.

Emergency Disaster Plan last updated on 1/30/24. Fire Drill conducted on November 6, 2024. Liability Insurance expired on 1/15/2025.

LPA reviewed 3 staff and 6 residents records and interviewed 2 staff and 2 residents. Medications were checked and compared with doctor's orders and LIC622 Centrally Stored and Medication Records. Facility does not handle residents' cash resources.

No Deficiencies cited. Exit interview conducted with administrator and a copy of this report was provided.

SUPERVISORS NAME: Bennett Fong
LICENSING EVALUATOR NAME: Kelly Nguyen
LICENSING EVALUATOR SIGNATURE: DATE: 12/30/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/30/2024
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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