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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 019201039
Report Date: 01/24/2025
Date Signed: 01/24/2025 04:29:21 PM

Document Has Been Signed on 01/24/2025 04:29 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:CAREFIELD PLEASANTONFACILITY NUMBER:
019201039
ADMINISTRATOR/
DIRECTOR:
O'FARRELL, EUNICEFACILITY TYPE:
740
ADDRESS:4115 MOHR AVE.TELEPHONE:
(925) 461-8409
CITY:PLEASANTONSTATE: CAZIP CODE:
94566
CAPACITY: 82CENSUS: 49DATE:
01/24/2025
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
12:50 PM
MET WITH:Eunice O'Farrell, Executive DirectorTIME VISIT/
INSPECTION COMPLETED:
02:25 PM
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On 1/24/2025 at 12:50PM, Licensing Program Analyst (LPA) G. Luk arrived unannounced to conduct a case management visit in regards to death report received on 1/20/2025. LPA met with Executive Director, Eunice O'Farrell and explained the purpose of the visit.

Death report revealed that R1 was found unresponsive by staff and 911 was called. R1 passed away at the hospital on 1/15/2025 with cause of death unknown.

LPA interviewed staff and reviewed documents including R1's physician's report, care plan, and facility notes. On 1/15/2025, staff found R1 looking pale and unresponsive while in bed. R1's physician's report revealed that R1 had long standing persistent fibrillation. Staff called 911 and R1 was transported to the hospital. Family notified facility staff that R1 passed away later that day at the hospital.


No deficiencies are being cited on this date.


Exit interview conducted. A copy of this report provided.
SUPERVISORS NAME: Harpreet Humpal
LICENSING EVALUATOR NAME: Grace Luk
LICENSING EVALUATOR SIGNATURE: DATE: 01/24/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/24/2025
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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