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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 019201413
Report Date: 03/14/2025
Date Signed: 03/14/2025 06:54:47 PM

Document Has Been Signed on 03/14/2025 06:54 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:RHOME CARES AT LYNNFACILITY NUMBER:
019201413
ADMINISTRATOR/
DIRECTOR:		NARULA, BITTUMFACILITY TYPE:
740
ADDRESS:1051 LYNN STTELEPHONE:
(510) 304-6085
CITY:LIVERMORESTATE: CAZIP CODE:
94550
CAPACITY: 6CENSUS: 6DATE:
03/14/2025
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
02:00 PM
MET WITH:Bittum Narula, Licensee/ApplicantTIME VISIT/
INSPECTION COMPLETED:
05:00 PM
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On 3/14/2025 at 2:00PM, Licensing Program Analyst (LPA) G. Luk conducted a Pre-licensing Inspection. LPA met with caregiver, Florante Tanjuatco and Licensee/Applicant, Bittum Narula arrived 30 minutes later.

LPA toured facility including but not limited to resident's bedrooms, bathrooms, living room, dining area, kitchen, garage, and outdoor area. LPA observed lighting in all rooms. Hot water was measured at 105 degrees F in the hallway bathroom. Facility bathrooms have grab bars and non-skid mat/materials for the showers. LPA observed facility have one week of non-perishable and two day of perishable food supplies available. Carbon monoxide detector was observed. Smoke detectors are interconnected with the sprinkler system. Fire extinguisher was observed to be full and last serviced on 6/13/2024. First aid kit was complete.

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

1. LPA observed R1 is in room #1 which the new fire clearance states room #1 is ambulatory only. However, R1's physician's report states that R1 is non-ambulatory.

2. LPA observed broken lock in the garage cabinet, a hole in the living room ceiling, missing screen door, a hole in another screen door, a hole in the bathroom's window screen, a hole on the deck near living room, and items that need to be disposed in the backyard.

3. LPA observed there's only one night light in the hallway and hallway bathrooms does not have night lights.

4. LPA observed there's no space on the bulletin board for residents to post flyers and meeting information.

5. LPA observed LIC610E (Emergency Disaster Plan) did not address fire safety precautions specific to evacuation of residents who are bedridden in the event of an emergency or disaster.

Licensee/Applicant will submit proof of corrections to CCLD on/before 4/1/2025.


Exit interview conducted and a copy of this report provided.
SUPERVISORS NAME: Harpreet Humpal
LICENSING EVALUATOR NAME: Grace Luk
LICENSING EVALUATOR SIGNATURE: DATE: 03/14/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/14/2025
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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