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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 075600296
Report Date: 10/28/2025
Date Signed: 10/28/2025 04:14:25 PM

Document Has Been Signed on 10/28/2025 04:14 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/
DIRECTOR:		DILLON VARIZFACILITY TYPE:
775
ADDRESS:801 FERRY STREETTELEPHONE:
(925) 229-8228
CITY:MARTINEZSTATE: CAZIP CODE:
94553
CAPACITY: 30CENSUS: 19DATE:
10/28/2025
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
03:00 PM
MET WITH:Dillon Variz, Program ManagerTIME VISIT/
INSPECTION COMPLETED:
04:30 PM
NARRATIVE
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On 10/28/2025 at 3:00 PM, Licensing Program Analyst (LPA) L. Alexander conducted an unannounced Case Management visit regarding incident reports submitted to the Community Care Licensing Division (CCLD) on 08/12/2025, 08/29/2025 and 10/01/2025. LPA met with Program Manager, Dillon Variz, and explained the purpose of the visit.

The Special Incident Reports (SIRs) indicated that on two separate occasions—08/29/2025 and 09/30/2025 Client (C1) eloped from the day program. According to the reports, C1 ran out of the program building and across the street without checking for oncoming traffic. Staff (S1), who was assigned to provide 1:1 supervision for C1, immediately followed C1 across the street. Staff (S1) and Staff (S2) were able to redirect C1 safely back into the program without further incident. C1's physicians reports shows unable to leave unassisted.



The SIR reported that on 08/11/2025 while the group was standing near the door preparing to transition outside, C2 eloped from the group. Staff (S1) and (S2) immediately began searching the surrounding area but were unable to locate C2. Approximately a few minutes later, Staff (S4) observed C2 sitting on a bench in the parking lot. The report noted that C2 has a history of eloping during community group outings. C2's physicians reports shows unable to leave unassisted.

LIC809-C Continued
NAME OF LICENSING PROGRAM MANAGER: Bennett Fong
NAME OF LICENSING PROGRAM ANALYST: Lori Alexander-Washington
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 10/28/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/28/2025
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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California Health & Human Services Agency
California Department of Social Services

FACILITY EVALUATION REPORT California law requires a public report of each licensing visit/inspection. This report is a record for the facility and the licensing agency. This report is available for public review; therefore, care is taken not to disclose personal or confidential information. Inquiries concerning the location, maintenance, and contents of these reports may be directed to the Licensing Program Analyst or Regional Office whose address and telephone number are listed on the front of this form.

DEFICIENCIES A deficiency is an instance of noncompliance with licensing requirements, including applicable statutes, regulations, interim licensing standards, operating standards, and written directives. Applicants/ licensees must be notified in writing of all licensing deficiencies. Deficiencies are listed on the left side of this form, and the applicable licensing requirement upon which the deficiency is identified. There are two types of deficiencies:
  • Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.
  • Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care.

PLANS OF CORRECTION (POCs) The licensing agency is required to establish a reasonable length of time to correct a deficiency. In order to set the time, the licensing agency must take into consideration the seriousness of the violation, the number of persons in care involved, and the availability of equipment and personnel necessary to correct the violation. Applicants/licensees are requested to provide a specific plan for each violation on the right side of the form across from each deficiency. The more specific the plan, the less chance exists for any misunderstanding in setting time limits and reviewing corrections. The applicant/licensee who encounters problems beyond their control in completing the corrections within the specified time frame may request and may be granted an extension of the correction due date by the licensing agency.

CORRECTION NOTIFICATION The applicant/licensee is responsible for completing all corrections and promptly notifying the licensing agency of corrections. Applicants/licensees are advised to keep a dated copy of any correspondence sent to the licensing agency concerning corrections, or if corrections are telephoned to the licensing agency, the date, person contacted, and information given.

CIVIL PENALTIES The licensing agency is required by law to issue a Penalty Notice, when applicable, to all facilities holding a license issued by the licensing agency, or subject to licensure, except Certified Family Homes, Resource Families, and Foster Family Homes, or any governmental entity.

PENALTY NOTICE GIVEN The statement concerning civil penalties serves as a penalty notice on this Licensing Report and failure to correct cited licensing deficiencies will result in civil penalties. Applicants/ licensees are required to pay civil penalties when administrative appeals have been exhausted and in accordance with any payment arrangements made with the licensing agency.

APPEAL RIGHTS The applicant/licensee has a right without prejudice to discuss any disagreement in this report with the licensing agency concerning the proper application of licensing requirements. The applicant/ licensee may request a formal review by the licensing agency to amend or dismiss the notice of deficiency and/ or civil penalty. Requests for review shall be made in writing within 15 business days of receipt of a deficiency notification or civil penalty assessment. Licensing deficiencies may be appealed pursuant to the procedures in the LIC 9058 Applicant/Licensee Rights.

AGENCY REVIEW The licensing agency review of an appeal may be conducted based upon information provided in writing by the applicant/licensee. The applicant/licensee may request an office meeting to provide additional information. The applicant/licensee will be notified in writing of the results of the agency review within 60 business days of the date when all necessary information has been provided to the licensing agency.

EMAIL REQUIREMENT Adult Community Care Facilities, Residential Care Facilities for the Chronically Ill, and Residential Care Facilities for the Elderly are required to provide and maintain an active email address of record with the licensing agency.

LIC809 (FAS) - (09/23)
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Document Has Been Signed on 10/28/2025 04:14 PM - It Cannot Be Edited


Created By: Lori Alexander-Washington On 10/28/2025 at 02:59 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: REHABILITATION & EMP. SVCS. OF THE EAST BAY, INC.
FACILITY NUMBER: 075600296

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/28/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
11/28/2025
Section Cited
CCR
82072(a)(2)

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82072 Personal Rights
(a) Each client shall have personal rights which include, but are not limited to, the following: (2) To be accorded safe, healthful and comfortable accommodations...

This requirement is not met as evidenced by:
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Administrator agreed to meet with C1's and C2's inter-disciplinary team including but not limited to clients' parents, house administrator, RCEB case managers to discuss and create a detailed plan on how to mitigate the
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Based on interview and record review the licensee did not comply with the section cited above by not according safety precautions resulting in C1 eloping and crossing the streets. Also, C2 eloped from the group before going on a community outing which posed a potential safety risk to persons in care.
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elopements. Administrator will submit the detailed plan to CCLD for review by POC due date.

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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
Bennett Fong
NAME OF LICENSING PROGRAM MANAGER:
Lori Alexander-Washington
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 10/28/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/28/2025


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: 10/28/2025
NARRATIVE
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LIC809-C (Page 2)

LPA interviewed S3. S3 stated that C1 has a history of elopement behaviors and can become easily over stimulated during group activities. On both occasions, C1 abruptly left the activity area and ran toward the exit door. S1 reported maintaining visual supervision but was unable to physically block C1 before exiting the building. S1 followed immediately to ensure C1’s safety. S2 assisted S1 in verbally redirecting C1 back into the building.

The following deficiencies were observed (see LIC 809D) and cited from the California Code of Regulations, Title 22 and/or Health and Safety Code Failure to correct deficiencies by POC date may result in additional Civil Penalties.

Exit interview conducted. Appeal Rights and a copy of this report provided.
NAME OF LICENSING PROGRAM MANAGER: Bennett Fong
NAME OF LICENSING PROGRAM ANALYST: Lori Alexander-Washington
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 10/28/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/28/2025
LIC809 (FAS) - (06/04)
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