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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 019201280
Report Date: 02/07/2024
Date Signed: 02/07/2024 10:34:52 AM

Document Has Been Signed on 02/07/2024 10:34 AM - 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:LEAP CARE SERVICES LLCFACILITY NUMBER:
019201280
ADMINISTRATOR:ECHON, RICARDOFACILITY TYPE:
740
ADDRESS:4336 EAST AVENUETELEPHONE:
(925) 223-7791
CITY:LIVERMORESTATE: CAZIP CODE:
94550
CAPACITY: 6CENSUS: 0DATE:
02/07/2024
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
09:10 AM
MET WITH:Carl Arcosa, Licensee/ApplicantTIME COMPLETED:
10:50 AM
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On 2/7/2024 at 9:10AM, Licensing Program Analyst (LPA) G. Luk conducted a Pre-licensing Inspection to verify corrections were made. LPA met with Licensee/Applicant, Carl Arcosa.

The facility's fire clearance was approved for 2 ambulatory and 4 non-ambulatory residents.



LPA toured facility including but not limited to resident's bedrooms, bathrooms, living room, kitchen, and outdoor area. LPA observed fire extinguishers to be full and purchase receipt attached dated 1/30/2024. Smoke detectors were observed in operating condition. Hallway bathrooms has night lights and bathrooms have paper towel holders installed. LPA observed bedroom #1 and #5 have chest of drawers for each residents. LPA observed beds have mattress pads. LPA measured hot water at 119.2 degrees F in the hallway bathroom sink. Licensee provided a copy of the updated dementia plan to address behaviors such as ingestion of toxic chemicals and wandering behaviors.

The following will need to be completed before recommending licensure to Centralized Application Bureau (CAB):


LPA observed a portion of the back fence is leaning away from the facility. Licensee stated the contractor will be at the facility today to assess the fence. Licensee will submit pictures of fence repair to CCLD.

Licensee/Applicant will submit proof of corrections to CCLD on/before 2/20/2024.

Exit interview conducted and a copy of this report provided.
SUPERVISORS NAME: Harpreet Humpal
LICENSING EVALUATOR NAME: Grace Luk
LICENSING EVALUATOR SIGNATURE: DATE: 02/07/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/07/2024
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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