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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 071440493
Report Date: 05/10/2022
Date Signed: 05/10/2022 03:49:27 PM

Document Has Been Signed on 05/10/2022 03:49 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: 25DATE:
05/10/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
02:40 PM
MET WITH:Amber Avalos, Community Program DirectorTIME COMPLETED:
04:00 PM
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On 05/10/2022 at 02:40 PM, Licensing Program Analyst (LPA) L. Holmes arrived unannounced to conduct an Infection Control Inspection, LPA was greeted by one staff upon entry and explained the purpose of the visit. Administrator, Amanda Eicher (ADM) was telephoned by the staff member and Amber Avalos, Community Programs Director was advised to assist me.

Facility has a COVID-19 mitigation plan on file. LPA requested a staff and resident roster. LPA observed a screening station at the entry with COVID-19 signage, a visitor sign-in log, thermometer, sanitizer, and masks. There is a surplus of PPE centrally located. LPA observed hand washing and COVID-19 signs posted. All hand washing stations were equipped with soap, paper towels covered and covered garbage cans. Hot water temperature in the shared clients' bathroom was measured at 108.2 degrees Fahrenheit (F). Fire extinguisher last inspected 02/09/2021 and was observed full. Smoke/Carbon Monoxide detectors were observed operational. Amber was advised to service the fire extinguisher and first aid kit is complete.

The following forms are to be updated and submitted to CCLD
-LIC500 Personnel Report (Received)
-LIC308 Designation of Administrative Responsibility
-LIC610 Emergency Disaster Plan (Reviewed)
-An updated copy of Administrator Certificate(s)

Exit interview conducted and a copy of this report provided.
SUPERVISORS NAME: Yvonne Flores-Larios
LICENSING EVALUATOR NAME: Lisha Holmes
LICENSING EVALUATOR SIGNATURE: DATE: 05/10/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/10/2022
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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