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

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 079201387
Report Date: 09/26/2024
Date Signed: 09/26/2024 01:46:01 PM

Document Has Been Signed on 09/26/2024 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
OAKLAND ASC, 1515 CLAY STREET, STE. 310
OAKLAND, CA 94612
FACILITY NAME:BR CAREFACILITY NUMBER:
079201387
ADMINISTRATOR/
DIRECTOR:		BERNARDINO-RUIZ, JAMIEFACILITY TYPE:
740
ADDRESS:2830 HAWTHORN CTTELEPHONE:
(925) 698-1207
CITY:BRENTWOODSTATE: CAZIP CODE:
94513
CAPACITY: 6CENSUS: 0DATE:
09/26/2024
TYPE OF VISIT:PrelicensingANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
11:00 AM
MET WITH:JAMIE BERNARDINO-RUIZ, ADMINISTRATORTIME VISIT/
INSPECTION COMPLETED:
02:15 PM
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 09/26/2024 at 11:00am, Licensing Program Analyst (LPA) T.Syess-Gibson conducted an announced pre-licensing visit and met with applicant Jamie Bernardino-Ruiz, Administrator. LPA explained the purpose of the visit with Administrator. The facility has an approved fire safety clearance for total capacity of six (6) residents, five(5) non ambulatory and one (1) bedridden residents.

LPA inspected the facility inside and out including but not limited to the bedrooms, bathrooms, common living areas, kitchen, garage, back yard. The facility has ten (10) bedrooms and four (4) bathrooms. Four (4) bedrooms available for staff. There is sufficient lighting around the facility.

LPA observed all six (6) residents' rooms equipped with hospital beds without bed rails, each bed had clean linen, including blankets, bedspreads, top bed sheets, bottom bed sheets, pillow cases and mattress pads. All rooms have proper lighting. LPA observed Bathrooms showers/tubs were equipped with grab bars, non-skid mats and hygiene supplies were observed inside cabinet. LPA observed television in the common area and board games for activities.

Communal dining room is equipped with sufficient tables and chairs for the residents. All toxins and sharp objects were locked inside the laundry and kitchen areas. Passageways and hallways were free of obstruction. Fire extinguishers were last purchased on 05/15/2024. Smoke detectors and Carbon Monoxide detectors were operational. Medication cabinet was locked, and first aid kit was complete.

All exit doors in the facility are equipped with auditory signals. Hot water temperature is measured at 116.8 degrees F. Emergency Disaster plans are complete and easily accessible to staff. Comfortable temperature was observed at 74 degrees F.


Continue on LIC809C
SUPERVISORS NAME: Harpreet Humpal
LICENSING EVALUATOR NAME: Tonica Syess-Gibson
LICENSING EVALUATOR SIGNATURE: DATE: 09/26/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/26/2024
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 2
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
OAKLAND ASC, 1515 CLAY STREET, STE. 310
OAKLAND, CA 94612
FACILITY NAME: BR CARE
FACILITY NUMBER: 079201387
VISIT DATE: 09/26/2024
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
26
27
28
29
30
31
32
Continue from LIC809

No issues noted during this pre-licensing inspection.

Component III was conducted with Jamie Bernardino-Ruiz on pre-licensing visit dated 09/26/2024. The applicant was reminded of the statute that requires CCL to be notified within 5 business days of admitting their first resident. This notification may be done by phone, by mail, or by fax.


LPA observed the facility is ready to be licensed. This report will be submitted to the central application unit (CAU) and a final review of the application will be conducted. This facility is not yet licensed and is subject to final approval by CAU. Additional requirements may still be required.


Exit interview conducted and a copy of this report provided.
SUPERVISORS NAME: Harpreet Humpal
LICENSING EVALUATOR NAME: Tonica Syess-Gibson
LICENSING EVALUATOR SIGNATURE:

DATE: 09/26/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/26/2024
LIC809 (FAS) - (06/04)
Page: 2 of 2