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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 079201290
Report Date: 09/28/2023
Date Signed: 09/28/2023 02:46:17 PM

Document Has Been Signed on 09/28/2023 02:46 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:A FAMILY OF CARE NO. 3FACILITY NUMBER:
079201290
ADMINISTRATOR:TAYLOR, KATHLEENFACILITY TYPE:
740
ADDRESS:528 NOTTINGHAM DRIVETELEPHONE:
(510) 755-7810
CITY:BRENTWOODSTATE: CAZIP CODE:
94513
CAPACITY: 6CENSUS: 0DATE:
09/28/2023
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Brian Friedel, Licensee
Kathleen Taylor, Administrator/Licensee
Mark Taylor, Licensee		TIME COMPLETED:
01:45 PM
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On 9/28/2023 at 10:00AM, Licensing Program Analyst (LPA) G. Luk conducted a Pre-licensing Inspection. LPA met with Licensee/Applicant, Brian Friedel, Kathleen Taylor, and Mark Taylor. LPA inspected the facility inside and out including but not limited to bedrooms, bathrooms, dining room, kitchen, living room, and outdoor area. The facility maintained a comfortable temperature. Hot water temperature was measured at 115 degrees F in the hallway bathroom. LPA observed grab bars and non-skid materials in the bathrooms. Medication will be centrally stored in a locked closet in the staff room. Facility has some perishable and nonperishable food supplies, but licensee will purchase additional food supplies prior resident admissions. There were utensils, plates, bowls, and cups observed in the kitchen. Home is clean and well ventilated with appropriate lighting. Smoke and carbon monoxide combo detectors were observed in operating conditions. Fire extinguishers were observed to be full and purchased on 7/13/2023. First aid kit was complete. No bodies of water observed. LPA observed proof of liability insurance dated 9/26/2023.

No issues noted during inspection. LPA observed that facility is ready to be licensed. This report will be submitted to the Centralized Application Bureau (CAB) and a final review of the application will be conducted. This facility is not yet licensed and is subject to final approval by CAB. Additional requirements may still be required.

Exit interview conducted with Kathleen Taylor and a copy of this report provided.

SUPERVISORS NAME: Harpreet Humpal
LICENSING EVALUATOR NAME: Grace Luk
LICENSING EVALUATOR SIGNATURE: DATE: 09/28/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/28/2023
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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