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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 071440493
Report Date: 02/22/2023
Date Signed: 02/22/2023 03:13:09 PM

Document Has Been Signed on 02/22/2023 03:13 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: 32DATE:
02/22/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
02:10 PM
MET WITH:Arden Fredman, Co-AdministratorTIME COMPLETED:
03:30 PM
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On 02/22/2023 at 02:00 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 Arden Fredman, Co-Administrator was available to assist.

LPA observed a screening station at the entry with COVID-19 signage, a visitor sign-in log, thermometer, sanitizer, masks and COVID-19 questionnaire. The facility is active with Clients using several stations while social distancing. There is a surplus of PPE centrally located inside the facility. LPA observed hand washing and COVID-19 signs posted. All hand washing stations were equipped with soap, paper towels, and covered garbage cans. Hot water temperature at the shared sink measured at 117.1 degree Fahrenheit (F). Fire extinguisher last inspected 05/12/2022 and was observed full; two other fire extinguishers were present and observed full. Smoke/Carbon Monoxide detectors were observed operational. Two first aid kits; first aid kit is complete.

The following forms are to be updated and submitted to CCLD:
-LIC500 Personnel Report
-LIC308 Designation of Administrative Responsibility
-LIC610 Emergency Disaster Plan (Reviewed) - Change to current year.
-An updated copy of Administrator Certificate(s)
-Staff and Client roster

Exit interview conducted and a copy of this report provided.
SUPERVISORS NAME: Yvonne Flores-Larios
LICENSING EVALUATOR NAME: Lisha Holmes
LICENSING EVALUATOR SIGNATURE: DATE: 02/22/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/22/2023
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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