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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 019200981
Report Date: 01/26/2023
Date Signed: 01/26/2023 11:08:06 AM

Document Has Been Signed on 01/26/2023 11:08 AM - 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:ST JOHN CORINTHIAN CARE, LLCFACILITY NUMBER:
019200981
ADMINISTRATOR:HODGE, MARCIEFACILITY TYPE:
772
ADDRESS:1000- 102TH STREETTELEPHONE:
(510) 325-8723
CITY:OAKLANDSTATE: CAZIP CODE:
94603
CAPACITY: 6CENSUS: 0DATE:
01/26/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:20 AM
MET WITH:Marcie Hodge, AdministratorTIME COMPLETED:
11:15 AM
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On 1/26/2023 at 10:20 AM, Licensing Program Analyst (LPA) P. Watson arrived unannounced to conduct an annual Infection Control Inspection. LPA met with Administrator, Macie Hodge and explained the purpose of the visit.

During the Infection Control Inspection, LPA toured facility with Macie including but not limited to front entrance, hand washing stations, bedrooms, common areas, kitchen, and backyard. A sign-in policy, thermometer and hand sanitizer were observed at screening station. Cough/sneeze etiquette, social distancing and hand washing posters were observed. Common touched surfaces are disinfected at least once daily.
Bathrooms are equipped with liquid soap, paper towel and trash bins. Facility has a 30 day supply of PPEs maintained at central location. Facility has a mitigation plan. Smoke and carbon monoxide detectors were observed and maintained. First Aid kit was complete. Fire extinguishers were observed serviced. LPA observed facility passages inside and out free of obstruction


No deficiencies cited during visit. Exit interview conducted and a copy of this report provided.
SUPERVISORS NAME: Yvonne Flores-Larios
LICENSING EVALUATOR NAME: Paris Watson
LICENSING EVALUATOR SIGNATURE: DATE: 01/26/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/26/2023
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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