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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 019200446
Report Date: 07/12/2022
Date Signed: 07/12/2022 06:23:24 PM

Document Has Been Signed on 07/12/2022 06:23 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:BRIDGESFACILITY NUMBER:
019200446
ADMINISTRATOR:SOKODOLO, KOLU G.FACILITY TYPE:
735
ADDRESS:21259 BIRCH ROADTELEPHONE:
(510) 244-7153
CITY:HAYWARDSTATE: CAZIP CODE:
94541
CAPACITY: 4CENSUS: 4DATE:
07/12/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
12:45 PM
MET WITH:Kolu Sokodolo/Administrator and
Lorenzo Pennix/Regional Director		TIME COMPLETED:
03:45 PM
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Licensing Program Analyst (LPA) Delmundo conducted an unannounced annual/infection control inspection. LPA met with Administrator Kolu Sokodolo, Regional Director Lorenzo Pennix and staff, Ireneo Pascual. LPA informed the purpose of visit.

Facility has an approved LIC808 Mitigation Plan on file. Administrator submitted the facility's new Infection Control Plan and received by LPA on June 29, 2022.

LPA toured the facility inside out with Kolu Sokodolo. LPA inspected the living room, dining area, kitchen, hallways, bedrooms, common bathroom, side and backyard. There's adequate food supplies of perishables good for 2 days and non-perishables good for 7 days.

LPA observed screening station by the front entrance equipped with hand sanitizer, no touch temperature probe, surgical masks, disposable gloves and Visitor's Log. Visitor's temperature and symptom checks are done at the entrance. Residents and staff are screened for COVID-19 symptoms, and temperature checked and recorded daily. Facility keeps record of proof of vaccination of residents and staff. Supplies of PPEs checked and antigen test kits are readily available. Trash bins were observed with foot pedal operated lids. Bathroom lavatory was observed with liquid soap and paper towels in a dispenser.

Fire extinguishers checked and observed fully charge with tags showed serviced May 10, 2022. Hot water temperature in the common bathroom was tested and measured at 110.9 degrees Fahrenheit.


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SUPERVISORS NAME: Bennett Fong
LICENSING EVALUATOR NAME: Alicia Delmundo
LICENSING EVALUATOR SIGNATURE: DATE: 07/12/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/12/2022
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 4
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1515 CLAY STREET, STE. 310
OAKLAND, CA 94612
FACILITY NAME: BRIDGES
FACILITY NUMBER: 019200446
VISIT DATE: 07/12/2022
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LPA observed the following:
1. No hand washing poster in the common bathroom.
2. Supply of disposable gowns and surgical masks not sufficient for 30 days.

Administrator to submit the following updated/current documents by August 2, 2022:
1. LIC308 Designation of Facility Responsibility
2, LIC500 Personnel Report
3. LIC610D Emergency Disaster Plan
4. Proof of surety bond coverage

LPA learned during conversation with Kolu Sokodolo and Lorenzo Pennix that 3 staff quit last month. According to Lorenzo he is in the process of interviewing applicants. LPA requested Kolu to submit by tomorrow, July 13, 2022, copies of weekly staff schedule for 3 consecutive weeks starting this week.

No deficiency observed during today's inspection.

Exit interview conducted.and copy of this report provided.to Kolu Sokodolo.
SUPERVISORS NAME: Bennett Fong
LICENSING EVALUATOR NAME: Alicia Delmundo
LICENSING EVALUATOR SIGNATURE:

DATE: 07/12/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/12/2022
LIC809 (FAS) - (06/04)
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