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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 075601519
Report Date: 08/26/2024
Date Signed: 08/26/2024 03:18:37 PM

Document Has Been Signed on 08/26/2024 03:18 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
OAKLAND ASC, 1515 CLAY STREET, STE. 310
OAKLAND, CA 94612
FACILITY NAME:LAFAYETTE HEIGHTS RESIDENTIAL CARE IIFACILITY NUMBER:
075601519
ADMINISTRATOR/
DIRECTOR:		MOGADAM, JOANNEFACILITY TYPE:
740
ADDRESS:2267 SHANNON LANETELEPHONE:
(925) 979-1200
CITY:WALNUT CREEKSTATE: CAZIP CODE:
94598
CAPACITY: 6CENSUS: 0DATE:
08/26/2024
TYPE OF VISIT:Required - 1 YearANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
02:30 PM
MET WITH:Licensee Joanne MogadamTIME VISIT/
INSPECTION COMPLETED:
03:30 PM
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On 8/26/2024 at 2:30 PM, Licensing Program Analysts (LPAs) J Sampair and P Manalo arrived announced to conduct the Required Annual Inspection. Upon entry, LPAs identified themselves to the Licensee Joanne Mogadam.

The facility has no residents currently. The Licensee will inform the Regional Office if she has residents at the facility again.

The LPAs inspected the interior and exterior of the facility. The inspection of the physical plant included the kitchen, dining area, restrooms, community living spaces, resident rooms, storage areas, and the grounds of the facility. The fire extinguisher was replaced 1/6/2024.

The carbon monoxide and smoke detectors were fully operational. The LPAs observed required postings in the facility, including the Residential Care Facility for the Elderly Complaint Poster, Ombudsman and Personal Rights posters, and the Theft and Loss Policy.

No citations were issued during the inspection.

Exit interview conducted and a copy of this report provided.

SUPERVISORS NAME: Harpreet Humpal
LICENSING EVALUATOR NAME: James Sampair
LICENSING EVALUATOR SIGNATURE: DATE: 08/26/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/26/2024
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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