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

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 079200523
Report Date: 02/22/2023
Date Signed: 02/22/2023 11:16:53 AM

Document Has Been Signed on 02/22/2023 11:16 AM - 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:BRUIZ CAREHOMEFACILITY NUMBER:
079200523
ADMINISTRATOR:BERNARDINO-RUIZ, JAMIE AFACILITY TYPE:
740
ADDRESS:2353 DEMARTINI LANETELEPHONE:
(925) 634-8802
CITY:BRENTWOODSTATE: CAZIP CODE:
94513
CAPACITY: 6CENSUS: 5DATE:
02/22/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
10:50 AM
MET WITH:Jamie Ruiz,licensee/Administrator TIME COMPLETED:
11:45 AM
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 02/22/2023 at 10:50AM, Licensing Program Analyst (LPAs) L.Ibo arrived unannounced to conduct a case management visit. LPA called Administrator Jamie Ruiz and informed her the purpose of the visit to deliver the request PPE supplies.

Facility is currently on a covid19 outbreak. According to Administrator, the facility is currently stable and public health is monitoring the facility. No new covid19 cases during the LPA’s visit.

Exit interview conducted via phone call with Administrator. Administrator agreed to sign and send the copy of the report via email.
SUPERVISORS NAME: Harpreet Humpal
LICENSING EVALUATOR NAME: Leslie Ibo
LICENSING EVALUATOR SIGNATURE: DATE: 02/22/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/22/2023
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