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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 071440493
Report Date: 05/05/2022
Date Signed: 05/11/2022 02:22:36 PM


COMPREHENSIVE INSPECTION

Document Has Been Signed on 05/11/2022 02:22 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:NURTURING INDEPENDENCE THROUGH ARTISTICDEVELOPMENTFACILITY NUMBER:
071440493
ADMINISTRATOR:DYER, DEBORAHFACILITY TYPE:
775
ADDRESS:551 23RD STREETTELEPHONE:
(510) 620-0290
CITY:RICHMONDSTATE: CAZIP CODE:
94804
CAPACITY: 70CENSUS: DATE:
05/05/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
04:50 PM
MET WITH:Attempted VisitTIME COMPLETED:
05:15 PM
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On 05/05/2022 at 04:50 PM, Licensing Program Analyst (LPA) L. Holmes arrived unannounced to conduct an Infection Control Inspection. There wasn't any staff or clients present and the front, roll down, gate was locked. LPA dialed facility number on 510-620-0290 and the mailbox was full. LPA left voicemail message at the alternate number for Amanda on 415-425-2636 requesting a callback to confirm hours of operation. LPA documented the visit and left the facility.
SUPERVISORS NAME: Yvonne Flores-Larios
LICENSING EVALUATOR NAME: Lisha Holmes
LICENSING EVALUATOR SIGNATURE: DATE: 05/05/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/05/2022
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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