<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 071440493
Report Date: 02/07/2025
Date Signed: 02/07/2025 02:11:41 PM

Document Has Been Signed on 02/07/2025 02:11 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/
DIRECTOR:		EICHER, AMANDAFACILITY TYPE:
775
ADDRESS:551 23RD STREETTELEPHONE:
(510) 620-0290
CITY:RICHMONDSTATE: CAZIP CODE:
94804
CAPACITY: 80CENSUS: 33DATE:
02/07/2025
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
12:15 PM
MET WITH:Shantanice Swain, Studio DirectorTIME VISIT/
INSPECTION COMPLETED:
02:30 PM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
On 02/07/2025 around 12:15 PM, Licensing Program Analyst (LPA) L. Holmes arrived unannounced to conduct a Case Management regarding an Unusual Incident Report (UIR) received by CCL 0n 02/06/24. LPA was greeted by one staff upon entry and met with Shantanice Swain, Studio Director (S4) and explained the purpose of the visit.

While on desk duty, LPA reviewed an Unusual Incident Report (UIR) regarding self-injurious behaviors with scissors at C1’s Day Program. Interviews with Witness #1 (W1) and S3 revealed that this was the third occurrence at the Day Program. W1 stated that he/she did not initially know why C1’s toe was bleeding until it was report by the Day Program. Due to the nature of the Day Program being an art studio, LPA advised S1 and S3 that scissors would need to be locked and/or supervised based on the needs and services of the clients. After reviewing C1's records, two prior incidents occurred on 10/25/24 and 12/05/24. S4 provided additional details that the incident occurred in the fiber department, facilitators will be advised that a lockbox will secure all sharps, and the scissors at the front desk were removed during the visit. C1's Day Program, ARF and RCEB will be notified in an effort to provide assistance and mitigate C1's behaviors.

- Around 12:15 PM, LPA observed 2-3 unlocked scissors stored in cup holders at the front desk.

Deficiency is cited per Title 22 California Code of Regulations and listed on LIC9099D. Failure to submit proof of corrections (POC) by plan of correction due date and/or any repeat deficiencies within a 12-month period may result in civil penalties.

Exit interview conducted, a copy of the appeal rights, and this report provided Shantanice Swain, Studio Director



SUPERVISORS NAME: Yvonne Flores-Larios
LICENSING EVALUATOR NAME: Lisha Holmes
LICENSING EVALUATOR SIGNATURE: DATE: 02/07/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/07/2025
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 2
Document Has Been Signed on 02/07/2025 02:11 PM - It Cannot Be Edited


Created By: Lisha Holmes On 02/07/2025 at 01:14 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: 02/07/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
02/07/2025
Section Cited
CCR
82078(a)

1
2
3
4
5
6
7
82078 Responsibility for Providing Care and Supervision (a) The licensee shall provide care and supervision necessary to meet the client's needs and all services specified in the admission agreement. -This requirement is not met as evidenced by:
1
2
3
4
5
6
7
S4 locked all sharps and cleared citation during the visit.
8
9
10
11
12
13
14
Based on observation, the licensee did not comply with the section cited above. LPA observed unlocked and unsupervised scissors during the visit on 01/30/25 02/07/25 which poses/posed a immediate health, safety and personal rights risk to persons in care.
8
9
10
11
12
13
14

1
2
3
4
5
6
7
1
2
3
4
5
6
7

1
2
3
4
5
6
7
1
2
3
4
5
6
7
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:Yvonne Flores-Larios
LICENSING EVALUATOR NAME:Lisha Holmes
LICENSING EVALUATOR SIGNATURE:
DATE: 02/07/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/07/2025


LIC809 (FAS) - (06/04)
Page: 2 of 2