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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 079200977
Report Date: 05/25/2023
Date Signed: 05/25/2023 12:03:18 PM

Document Has Been Signed on 05/25/2023 12:03 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:WE CARE ELDERLY CAREFACILITY NUMBER:
079200977
ADMINISTRATOR:WHITE, BRITTANY DFACILITY TYPE:
740
ADDRESS:4155 BELL AVETELEPHONE:
(510) 375-4460
CITY:RICHMONDSTATE: CAZIP CODE:
94804
CAPACITY: 8CENSUS: 5DATE:
05/25/2023
TYPE OF VISIT:Case Management - Annual ContinuationANNOUNCEDTIME BEGAN:
11:35 AM
MET WITH:Tenilius Hampton, Care Staff TIME COMPLETED:
12:30 PM
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On 05/25/23 around 11:35 AM, Licensing Program Analyst (LPA) L. Holmes arrived announced for a case management to complete the annual continuation inspection from 05/23/23. Upon arrival, LPA met with Tenilius Hampton, Care Staff and explained the reason for the visit. Brittany White (ADM) was telephoned by LPA, and Care Staff is approved to sign the report.

LPA completed the inspection tool, LIC858, LIC859, staff and resident interviews.

Exit interview conducted and a copy of the report was provided to Tenilius Hampton, Care Staff.
SUPERVISORS NAME: Yvonne Flores-Larios
LICENSING EVALUATOR NAME: Lisha Holmes
LICENSING EVALUATOR SIGNATURE: DATE: 05/25/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/25/2023
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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