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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 075600296
Report Date: 10/30/2023
Date Signed: 10/30/2023 01:46:05 PM

Document Has Been Signed on 10/30/2023 01:46 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
E BAY DELTA AC/SC, 1515 CLAY STREET, STE. 310
OAKLAND, CA 94612
FACILITY NAME:REHABILITATION & EMP. SVCS. OF THE EAST BAY, INC.FACILITY NUMBER:
075600296
ADMINISTRATOR:BREMNER, IANFACILITY TYPE:
775
ADDRESS:801 FERRY STREETTELEPHONE:
(925) 229-8228
CITY:MARTINEZSTATE: CAZIP CODE:
94553
CAPACITY: 30CENSUS: 21DATE:
10/30/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
11:00 AM
MET WITH:Dillon Variz, Program ManagerTIME COMPLETED:
02:00 PM
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On 10/30/2023 at 11:00 AM, Licensing Program Analysts (LPAs) L. Alexander and P. Watson arrived unannounced to conduct 1-Year Annual Required inspection. LPAs met with Program Manager, Dillon Variz and explained the purpose of the visit. Day program operates from 9:15 AM to 3:30 PM. There were 8 staff observed working with the 21 clients here today.

LPAs toured facility with Dillon including but not limited to, multiple activity rooms, kitchen, bathrooms, and office space. Clients bring their own lunches and snacks. Emergency supplies, including water were observed. The hot water temperature in the client bathroom measured 109.3 degrees Fahrenheit and 96.0 degrees Fahrenheit in the Kitchen. Cleaning supplies are locked and inaccessible to clients. Medications are dispensed by this program. There are no bodies of water or fire safety hazards observed. Restrooms are maintained in safe and in sanitary operating condition, and additional equipment for the physically handicapped was observed. Incontinent clients are kept clean and dry, and the facility is free of odors. The program has 1 van used for client outings. Van maintenance logs were reviewed. Client and staff files were reviewed and observed to be completed. Emergency disaster drills are conducted on a weekly basis at different times by each instructor. Fire extinguishers throughout facility were last inspected 08/01/2023. First aid kit was completed.

LIC 809C Continued....
SUPERVISORS NAME: Bennett Fong
LICENSING EVALUATOR NAME: Lori Alexander-Washington
LICENSING EVALUATOR SIGNATURE: DATE: 10/30/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/30/2023
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
E BAY DELTA AC/SC, 1515 CLAY STREET, STE. 310
OAKLAND, CA 94612
FACILITY NAME: REHABILITATION & EMP. SVCS. OF THE EAST BAY, INC.
FACILITY NUMBER: 075600296
VISIT DATE: 10/30/2023
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LIC809 Continued....


The following forms to be updated and submitted to CCL by 11/06/2023:

LIC 308 Designation of Administrative Responsibility
LIC 309 Administrative Organization
LIC 500 Personnel Report
LIC 610 Emergency Disaster Plan (9 Pages)



No deficiencies cited during visit. Exit interview conducted and a copy of this report provided.
SUPERVISORS NAME: Bennett Fong
LICENSING EVALUATOR NAME: Lori Alexander-Washington
LICENSING EVALUATOR SIGNATURE:

DATE: 10/30/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/30/2023
LIC809 (FAS) - (06/04)
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