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

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 019201183
Report Date: 11/21/2024
Date Signed: 11/21/2024 04:42:45 PM

Document Has Been Signed on 11/21/2024 04:42 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:SWEET CARE HOME IN UNION CITYFACILITY NUMBER:
019201183
ADMINISTRATOR/
DIRECTOR:		YALUNG, ELAINEFACILITY TYPE:
740
ADDRESS:32506 KAREN CTTELEPHONE:
(510) 487-2953
CITY:UNION CITYSTATE: CAZIP CODE:
94587
CAPACITY: 6CENSUS: 6DATE:
11/21/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
02:35 PM
MET WITH:Gloria Deogracias, Administrator TIME VISIT/
INSPECTION COMPLETED:
05:00 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 11/21/24 around 2:35PM Licensing Program Analyst (LPA) K. Nguyen conducted 1-year requirement annual inspection. License is for six (6) total capacity, all non-ambulatory of which one maybe bedridden. Fire clearance was granted on July 12, 2022. LPA met with Administrator (ADM), Gloria Deogracias and explain the purpose of the visit. Liability Insurance 10/31/24 to 10/31/2025.

LPA toured the facility inside out with ADM. There is no body of water. LPA inspected the living room, dining area, family room, kitchen, bedrooms, bathrooms, side and backyards. Bedrooms were observed appropriately furnished with adequate lighting and drawers. Facility has sufficient towels, extra bed sheets and comforters. Equipment and supplies for residents' personal hygiene are available and on site. Dinner and silver wares were observed sufficient for residents' use. Food supplies checked and observed sufficient good for seven days of non-perishables and 2 days of perishables. Cabinets were knives and closet were medications are centrally stored were observed locked.Bathrooms/showers were observed equipped with grab bars and non-skid mats. Complaint poster, Ombudsman and Personal Rights posters, Theft and Loss Policy, Rights to Resident Council and Rights to Family Council were observed posted in the prominent place. All exit doors were observed with auditory signals.

Fire extinguisher checked and observed fully charge with tag showed serviced April 18, 2024. Carbon monoxide and smoke detectors operational. First aid kit inspected. Facility has flash lights for emergency lighting. Hot water temperature in one of the common bathrooms was tested and measured at 103.4 degrees Fahrenheit. Facility has land line phone which LPA tested and observed operational. Fire drill 10/10/24. Emergency Disaster Plan was last reviewed on 11/21/2024. LPA reviewed 6 residents files and 3 staff records.

NO citation issue on today date. Exit interview conducted a copy is provided.
SUPERVISORS NAME: Bennett Fong
LICENSING EVALUATOR NAME: Kelly Nguyen
LICENSING EVALUATOR SIGNATURE: DATE: 11/21/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/21/2024
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 1