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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 011440756
Report Date: 10/25/2022
Date Signed: 10/25/2022 04:03:05 PM

Document Has Been Signed on 10/25/2022 04:03 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
E BAY DELTA AC/SC, 1515 CLAY STREET, STE. 310
OAKLAND, CA 94612
FACILITY NAME:BOBBI FRENCH RESIDENTIAL CARE FACILITYFACILITY NUMBER:
011440756
ADMINISTRATOR:FRENCH, BOBBI L.FACILITY TYPE:
735
ADDRESS:521 - 32ND STREETTELEPHONE:
(510) 428-9424
CITY:OAKLANDSTATE: CAZIP CODE:
94609
CAPACITY: 6CENSUS: 4DATE:
10/25/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
03:00 PM
MET WITH:Bobbi French, LicenseeTIME COMPLETED:
04:15 PM
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On 10/25/22 at 3:00pm, Licensing Program Analyst (LPA) C. Lin conducted an announced case management visit for the purpose of confirming that the facility has an active administrator on file. LPA met with the licensee and explained the purpose of the visit.

Based on the record reviewed, LPA observed that Norman Goolsby was listed as Administrator in Guardian portal. LPA advised the licensee what administrator responsibilities are and licensee acknowledged. The Licensee agrees to provide the required documents of changing administrator to CCL by 10/26/2022.

No deficiency cited during visit, exit interview conducted with the licensee and a copy of this report provided.
SUPERVISORS NAME: Bennett Fong
LICENSING EVALUATOR NAME: Catherine Lin
LICENSING EVALUATOR SIGNATURE: DATE: 10/25/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/25/2022
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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