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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 079200971
Report Date: 02/27/2024
Date Signed: 02/27/2024 03:31:29 PM

Document Has Been Signed on 02/27/2024 03:31 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:GOLF VIEW HOMEFACILITY NUMBER:
079200971
ADMINISTRATOR:HIPOLITO, LORICAFACILITY TYPE:
740
ADDRESS:332 PEBBLE BEACH DR.TELEPHONE:
(925) 418-5613
CITY:BRENTWOODSTATE: CAZIP CODE:
94513
CAPACITY: 6CENSUS: 5DATE:
02/27/2024
TYPE OF VISIT:Case Management - Health ChecksUNANNOUNCEDTIME BEGAN:
01:30 PM
MET WITH:Lorica Hiplito, AdminstratorTIME COMPLETED:
03:50 PM
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On 2/27/2024, Licensing Program Analyst (LPA) K. Nguyen arrived unannounced to conduct a health check as a result of a Priority 1 complaint. Upon entry, LPA stated the purpose of the visit to administrator, Lorica Hipolito.

LPA toured facility including but not limited to the bedrooms, bathrooms, common area, kitchen, garage and outdoor area. Facility temperature was maintained at 74 degrees F. More than the minimum of 7 days of non-perishable and 2 days of perishable food supplies were on hand. Resident medications were kept locked in the cabinet. Smoke and Carbon monoxide detectors tested and were functional. Fire extinguisher last purchased on 2/27/24. There are no accessible bodies of water observed.

There is no deficiency noted on this day.

Exit interview conducted and a copy of this report provided to administrator via email.
SUPERVISORS NAME: Bennett Fong
LICENSING EVALUATOR NAME: Kelly Nguyen
LICENSING EVALUATOR SIGNATURE: DATE: 02/27/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/27/2024
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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