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

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 019200464
Report Date: 10/11/2021
Date Signed: 10/11/2021 03:55:09 PM

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:J & C CARE CENTER LLCFACILITY NUMBER:
019200464
ADMINISTRATOR:CHING, JESSICAFACILITY TYPE:
740
ADDRESS:4240 REDDING STREETTELEPHONE:
(510) 482-0108
CITY:OAKLANDSTATE: CAZIP CODE:
94619
CAPACITY:25CENSUS: 18DATE:
10/11/2021
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
01:20 PM
MET WITH:Jessica Ching, AdministratorTIME COMPLETED:
04:05 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 10/11/2021 at 01:20PM, Licensing Program Analysts (LPAs) L. Hall and C Fowler conducted an unannounced Case Management visit regarding closure of facility. The eviction letter was dated 08/19/2021. LPAs met with Jessica Ching, Administrator, and explained the purpose of the visit.

Upon arrival LPAs observed 7 residents in hallway. LPAs toured bedrooms, bathrooms, and kitchen. LPAs counted 18 residents residing at facility. Administrator informed LPAs that facility is not closing at this time, but have not had the opportunity to notify the Department. Administrator will submit a letter to the Department, Residents and their Responsible Party's of the facility changes by 10/15/2021. Administrator clearly understands that if facility closes the previous eviction letter will be illegal.

LPAs observed the following deficiency:

- On 10/11/2021 at 02:10PM, LPAs observed four (4) unsanitary refrigerators in the kitchen. LPAs also observed gnats flying around the refrigerators and sink.

The deficiency was observed (see LIC809D) and cited from the California Code of Regulation, Title 22. Failure to correct the deficiency may result in civil penalties.

Exit interview conducted. A copy of this report and appeal rights provided.

SUPERVISOR'S NAME: Harpreet HumpalTELEPHONE: (510) 285-3928
LICENSING EVALUATOR NAME: Laura HallTELEPHONE: (510) 622-2024
LICENSING EVALUATOR SIGNATURE:

DATE: 10/11/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/11/2021
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
CCLD Regional Office, 1515 CLAY STREET, STE. 310
OAKLAND, CA 94612

FACILITY NAME: J & C CARE CENTER LLC
FACILITY NUMBER: 019200464
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/11/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
10/18/2021
Section Cited

1
2
3
4
5
6
7
87303 Maintenance and Operation (a)The facility shall be clean, safe, sanitary... Maintenance shall include... the safety and well-being of residents, employees and visitors. This requirement was not met as evidence by:
8
9
10
11
12
13
14
Based on LPAs observation Licensee did not comply with the section cited above, which imposes a potential health and safety risk to persons in care.
8
9
10
11
12
13
14

1
2
3
4
5
6
7

1
2
3
4
5
6
7
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME: Harpreet HumpalTELEPHONE: (510) 285-3928
LICENSING EVALUATOR NAME: Laura HallTELEPHONE: (510) 622-2024
LICENSING EVALUATOR SIGNATURE:
DATE: 10/11/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/11/2021
LIC809 (FAS) - (06/04)
Page: 2 of 2