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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 075600915
Report Date: 03/09/2022
Date Signed: 03/09/2022 11:55:14 AM

Document Has Been Signed on 03/09/2022 11:55 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:VALLEY VIEW CARE HOME IIIFACILITY NUMBER:
075600915
ADMINISTRATOR:ALIPING, JOEL & EMILYFACILITY TYPE:
740
ADDRESS:5117 RAINCLOUD DR.TELEPHONE:
(510) 222-5631
CITY:RICHMONDSTATE: CAZIP CODE:
94803
CAPACITY: 6CENSUS: 3DATE:
03/09/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:40 AM
MET WITH:Administrator, Joel AlipingTIME COMPLETED:
12:00 PM
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03/09/22 at 09:40 am, Licensing Program Analyst (LPA) L. Holmes conducted an unannounced infection control annual inspection. LPA met with Administrator, Joel Aliping and informed him of the purpose of the visit.

The facility had (2) two additional care staff and (2) two residents present. The facility's COVID-19 mitigation plan is on file.

LPA started the inspection with Joel Aliping. Hand sanitizer is outside at the front door. LPA observed a screening station located at the entrance with a visitor's log, thermometer, masks, gloves, and hand sanitizer. Routine symptom screening and temperature checks are done for all staff, residents and visitors. Residents are screened for COVID-19 symptoms and temperatures upon return from daily outings also.

An adequate supply of centrally stored PPEs were observed in the garage. There were at least 7 days of non-perishables and 2 days of perishable foods. Fire extinguisher observed fully charged and showed last inspected on 03/28/2021. First aid kit present and stocked. Joel M. Aliping Standard Certificate 6016976740 is valid from 05/25/2020 to 05/24/2022.
LPA recommended the following:
1. Add 20 seconds to handwashing signs in the kitchen, wash basin in the garage, upstairs and downstairs bathrooms,.
2. Add covered garbage cans to upstairs and downstairs bathrooms,.
3. Remove towels after each use in the upstairs bathroom and kitchen.
4. Create an isolation cart for isolation room number 2.
5. The downstairs screen door of the patio door is torn near the handle. The size is about 2 by 3 inches long. Advised to repair or replace screen door by 03/23/22.
SUPERVISORS NAME: Yvonne Flores-Larios
LICENSING EVALUATOR NAME: Lisha Holmes
LICENSING EVALUATOR SIGNATURE: DATE: 03/09/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/09/2022
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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