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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 071440493
Report Date: 03/08/2024
Date Signed: 03/08/2024 03:43:29 PM

Document Has Been Signed on 03/08/2024 03:43 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:EICHER, AMANDAFACILITY TYPE:
775
ADDRESS:551 23RD STREETTELEPHONE:
(510) 620-0290
CITY:RICHMONDSTATE: CAZIP CODE:
94804
CAPACITY: 70CENSUS: 32DATE:
03/08/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:20 AM
MET WITH:Ingrid Alonso-Rodriguez, Administrative Director
Arden Fredman, Senior Programs Director		TIME COMPLETED:
04:00 PM
NARRATIVE
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On 3/8/2024 at 10:20AM, Licensing Program Analyst (LPA) G. Luk arrived unannounced to conduct a Required - 1 Year inspection. LPA met with Administrative Director, Ingrid Alonso-Rodriguez and Senior Programs Director, Arden Fredman. The facility’s fire clearance was approved for 70 clients of which 10 may be non-ambulatory.

LPA toured the facility including but not limited to activity rooms, common areas, bathrooms, kitchen, and outdoor area. Facility has an outdoor activity space with shaded areas. Smoke and carbon monoxide detectors were observed. Fire extinguishers were observed to be full. Clients bring their lunches to the facility. Hot water temperature was measured at 117.7 degrees F in the kitchen sink. All observed toilets and hand washing stations are maintained in a safe, sanitary, and operating condition. First aid kit was complete. The last emergency drill was conducted on 2/29/2024.

LPA reviewed 4 clients and 4 staff files starting at 11:50AM. LPA interviewed 3 clients and 3 staff starting at 1:50PM.

At 12:00PM, LPA observed C2 does not have TB test on file during record review.

At 1:00PM, LPA observed S3 and S4 does not have current First Aid training. Additionally, facility did not have current CPR training for staff present at the facility.

At 1:30PM, LPA observed facility did not have current AED training for staff.

The deficiencies were observed (see LIC 809D) and cited from the California Code of Regulations, Title 22. Failure to correct deficiencies may result in civil penalties.

Exit interview conducted. A copy of this report and appeal rights provided.
SUPERVISORS NAME: Harpreet Humpal
LICENSING EVALUATOR NAME: Grace Luk
LICENSING EVALUATOR SIGNATURE: DATE: 03/08/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/08/2024
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 3
Document Has Been Signed on 03/08/2024 03:43 PM - It Cannot Be Edited


Created By: Grace Luk On 03/08/2024 at 03:02 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 1515 CLAY STREET, STE. 310
OAKLAND, CA 94612

FACILITY NAME: NURTURING INDEPENDENCE THROUGH ARTISTICDEVELOPMENT
FACILITY NUMBER: 071440493

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/08/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
82069(b)(1)
Client Medical Assessments
(b) The medical assessment shall include the following: (1) The results of an examination for communicable tuberculosis and other contagious/infectious diseases.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review, the licensee did not comply with the section cited above by not having TB test results for C2 which poses a potential health and safety risk to persons in care.
POC Due Date: 03/29/2024
Plan of Correction
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Facility has agreed to obtain TB test results for C2 and submit a copy to CCLD by POC date.
Type B
Section Cited
CCR
82075(f)
Health-Related Services
(f) Staff responsible for providing direct care and supervision shall receive and maintain current training in first aid and cardiopulmonary resuscitation from persons qualified by agencies including, but not limited to, the American Red Cross.

This requirement is not met as evidenced by:
Deficient Practice Statement
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2
3
4
Based on record review, the licensee did not comply with the section cited above by not having current First Aid and CPR training for staff which poses a potential health and safety risk to persons in care.
POC Due Date: 03/29/2024
Plan of Correction
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2
3
4
Facility has agreed to obtain First Aid training for S3 and S4. Facility will provided completion documents for First Aid training and CPR training to CCLD by POC date.
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 Humpal
LICENSING EVALUATOR NAME:Grace Luk
LICENSING EVALUATOR SIGNATURE:
DATE: 03/08/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/08/2024


LIC809 (FAS) - (06/04)
Page: 2 of 3
Document Has Been Signed on 03/08/2024 03:43 PM - It Cannot Be Edited


Created By: Grace Luk On 03/08/2024 at 03:02 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 1515 CLAY STREET, STE. 310
OAKLAND, CA 94612

FACILITY NAME: NURTURING INDEPENDENCE THROUGH ARTISTICDEVELOPMENT
FACILITY NUMBER: 071440493

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/08/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
82075.2(a)(3)(C)
Automated External Defibrillators (AEDs)
(a) A licensee is permitted to maintain and operate an AED at the day program if all of the following conditions are met: (3) The licensee shall maintain at the program site the following: (C) A copy of a valid AED operator's certificate for any employee(s) authorized by the licensee to operate the AED. The certificate shall indicate that the AED training course completed complies with the standards of the American Heart Association or the American Red Cross. If it does not, then other evidence indicating that the AED training course completed complies with the standards of the American Heart Association or the American Red Cross shall be available at the facility.

This requirement is not met as evidenced by:
Deficient Practice Statement
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2
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4
Based on record review, the licensee did not comply with the section cited above by not having current AED training for staff which poses a potential health and safety risk to persons in care.
POC Due Date: 03/29/2024
Plan of Correction
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2
3
4
Facility has agreed to obtain AED training for staff and provided completion documents to CCLD by POC date.
Section Cited
Deficient Practice Statement
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2
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4
POC Due Date:
Plan of Correction
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2
3
4
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 Humpal
LICENSING EVALUATOR NAME:Grace Luk
LICENSING EVALUATOR SIGNATURE:
DATE: 03/08/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/08/2024


LIC809 (FAS) - (06/04)
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