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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 015601307
Report Date: 10/09/2024
Date Signed: 10/09/2024 01:46:02 PM

Document Has Been Signed on 10/09/2024 01:46 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:RUUS HOME-RCFEFACILITY NUMBER:
015601307
ADMINISTRATOR/
DIRECTOR:
JUGARAP, SIMPORIANA P.FACILITY TYPE:
740
ADDRESS:28269 RUUS ROADTELEPHONE:
(510) 785-0875
CITY:HAYWARDSTATE: CAZIP CODE:
94544
CAPACITY: 6CENSUS: 4DATE:
10/09/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:30 AM
MET WITH:Simporiana (Bing) Jugarap, AdministratorTIME VISIT/
INSPECTION COMPLETED:
02:15 PM
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Licensing Program Analyst (LPA) K. Nguyen arrived unannounced to conduct an annual required inspection and met with caregiver Maria Levita Carrillo. Administrator, Simporiana (Bing) Jugarap arrived at the facility at a later time.

Facility has an approved fire clearance for 3 non ambulatory and 1 bedridden resident.

LPA inspected the facility inside and out including but not limited to 4 resident rooms, 2 bathrooms, kitchen, dining area backyard. Hot water measured at 101 degrees Fahrenheit. There was sufficient supply of perishable and non perishable foods. Linen, towels and warm blankets were observed. Hygiene products were available to the residents. There was fire extinguisher observed that appeared full and last inspected on 2/22/24. Smoke detectors and carbon monoxide were tested and observed operational. First aid kit was complete. Disaster plan, complaint poster, Ombudsman poster and other required notices were posted on the board in the hallway and dining area. Passageways and hallways were free of obstruction. Chemicals, medications as well as knives and other sharp objects were observed locked in different locations.

LPA reviewed money and log. Money was observed intact and log was updated. Facility has sufficient surety bond dated 11/8/2022 to 2026 to cover money being handled.

LPA reviewed 4 client files and 3 staff files. All staff are fingerprint cleared and have current first aid and CPR training. LPA reviewed medication and log. Last fire drill was conducted on 9/2/24.

No deficiencies noted for today's visit.

Exit interview is conducted and a report provided to Administrator.

SUPERVISORS NAME: Bennett Fong
LICENSING EVALUATOR NAME: Kelly Nguyen
LICENSING EVALUATOR SIGNATURE: DATE: 10/09/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/09/2024
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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