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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 079201227
Report Date: 03/16/2023
Date Signed: 03/16/2023 12:00:36 PM

Document Has Been Signed on 03/16/2023 12:00 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
E BAY DELTA AC/SC, 1515 CLAY STREET, STE. 310
OAKLAND, CA 94612
FACILITY NAME:CARE 4 ONE IIFACILITY NUMBER:
079201227
ADMINISTRATOR:ELGADO, LIZA JAYFACILITY TYPE:
740
ADDRESS:3910 BAYVIEW CIRTELEPHONE:
(925) 464-3891
CITY:CONCORDSTATE: CAZIP CODE:
94520
CAPACITY: 6CENSUS: 0DATE:
03/16/2023
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
09:50 AM
MET WITH:Liza Jay Elgado, AdministrartorTIME COMPLETED:
11:30 AM
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On 3/16/2023 at 9:50 AM, Licensing Program Analyst (LPA) P. Watson arrived announced to conduct Pre-Licensing inspection. LPA met with Administrator, Liza Jay Elgado and explained the purpose of the visit. The facility currently has no residents/clients.

LPA toured facility with Liza including but not limited to 4 bedrooms for residents, 2 rooms for staff, 3 bathrooms, kitchen, common areas and backyard. Bedrooms and living rooms were equipped with the proper furniture. Bathrooms were equipped with grab bars and non-skid mats. Linens and hygiene supplies were observed inside a cabinet. There is sufficient lighting throughout facility. Room temperature was maintained at 71 degrees F and hot water temperature was maintained at 110.8 degrees F. First-aid kit was observed to be complete. Smoke detectors and carbon monoxide were operational. Fire extinguisher was last serviced on 05/24/2022.


No issues noted during inspection. LPAs observed that facility is ready to be licensed. This report will be submitted to the Central Applications Bureau (CAB) and a final review of the application will be conducted. This facility is not yet licensed and is subject to final approval by CAB. Additional requirements may still be required.


Exit interview conducted and a copy of this report provided.
SUPERVISORS NAME: Yvonne Flores-Larios
LICENSING EVALUATOR NAME: Paris Watson
LICENSING EVALUATOR SIGNATURE: DATE: 03/16/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/16/2023
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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