<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 079201270
Report Date: 10/05/2023
Date Signed: 10/05/2023 02:32:39 PM

Document Has Been Signed on 10/05/2023 02:32 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:TOYON CARE IIFACILITY NUMBER:
079201270
ADMINISTRATOR:WEI, ANGELAFACILITY TYPE:
740
ADDRESS:2365 WRIGHT AVETELEPHONE:
(415) 606-6829
CITY:PINOLESTATE: CAZIP CODE:
94564
CAPACITY: 6CENSUS: 0DATE:
10/05/2023
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Angela Wei, Licensee/AdministratorTIME COMPLETED:
01:00 PM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
On 10/5/2023 at 9:30AM, Licensing Program Analyst (LPA) G. Luk conducted a Pre-licensing Inspection. LPA met with Licensee/Administrator, Angela Wei.

LPA inspected the facility inside and out including but not limited to bedrooms, bathrooms, dining room, kitchen, living room, garage, and outdoor area. Hot water temperature was measured at 118 degrees F in the hallway bathroom. LPA observed grab bars and non-skid mats in the bathrooms. LPA observed resident rooms were fully furnished with lighting. Medication will be centrally stored in a locked cabinet located in the kitchen. Facility has 2-day perishable and 7-day nonperishable food supplies available. There were utensils, plates, bowls, and cups observed in the kitchen. Home is clean and well ventilated with appropriate lighting. Smoke and carbon monoxide detectors were observed in operating conditions. Fire extinguishers were observed to be full and purchased on 10/5/2023. First aid kit was complete. No bodies of water observed.

Facility has rooms located on the second floor that will be occupied by staff only. Residents will have call button at night time and staff will have the signal system with them during night time.

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

- LPA observed facility's dementia plan does not address behaviors such as resident wandering and aggressive behaviors.

Licensee/administrator will submit proof of corrections to CCL on/before 10/18/2023.



Exit interview conducted and a copy of this report provided.
SUPERVISORS NAME: Harpreet Humpal
LICENSING EVALUATOR NAME: Grace Luk
LICENSING EVALUATOR SIGNATURE: DATE: 10/05/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/05/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 1