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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 075601193
Report Date: 02/10/2025
Date Signed: 02/10/2025 12:34:04 PM

Document Has Been Signed on 02/10/2025 12:34 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:DUCRE'S RESIDENTIAL CAREFACILITY NUMBER:
075601193
ADMINISTRATOR/
DIRECTOR:		DUCRE, DORIS RUTHFACILITY TYPE:
740
ADDRESS:4400 BELL AVENUETELEPHONE:
(510) 236-8776
CITY:RICHMONDSTATE: CAZIP CODE:
94804
CAPACITY: 6CENSUS: 5DATE:
02/10/2025
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
12:00 PM
MET WITH:Administrator, Doris DucreTIME VISIT/
INSPECTION COMPLETED:
12:45 PM
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On 02/09/23 at 12:00 PM, Licensing Program Analyst (LPA) L. Holmes arrived unannounced to conduct a required Annual Inspection and also conducted a Case Management for Resident #1 (R1's) skin care.

LPA reviewed R1's file, interviewed Staff #1 (S1) and R1. S1 stated that R1 was admitted to the facility on 12/18/2020 with Stasis Dermatitis that's documented on R1's LIC624 dated 02/25/2019. LPA observed R1's bandages. R1 stated that he/she is not in any pain. S1 stated the there is leakage from the skin and is progressively getting worse. Records revealed that R1 has had ongoing treatment with Standford Medicine, Kaiser Permanete, Apollo Home Heath and has approved medical supplies through Contra Costa Health Services. Per S1, once R1 is approved for Medicare this year (2025), R1 will have dual coverage and can explore additional options for more effective treatments.

Exit interview conducted and a copy of this report provided to Doris Ducre.
SUPERVISORS NAME: Yvonne Flores-Larios
LICENSING EVALUATOR NAME: Lisha Holmes
LICENSING EVALUATOR SIGNATURE: DATE: 02/10/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/10/2025
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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