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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 075601193
Report Date: 08/25/2021
Date Signed: 08/25/2021 04:51:26 PM



STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1515 CLAY STREET, STE. 310
OAKLAND, CA 94612
This is an official report of an unannounced visit/investigation of a complaint received in our office on
05/13/2020 and conducted by Evaluator Laura Hall
COMPLAINT CONTROL NUMBER: 15-AS-20200513151512
FACILITY NAME:DUCRE'S RESIDENTIAL CAREFACILITY NUMBER:
075601193
ADMINISTRATOR:DUCRE, DORIS RUTHFACILITY TYPE:
740
ADDRESS:4400 BELL AVENUETELEPHONE:
(510) 236-8776
CITY:RICHMONDSTATE: CAZIP CODE:
94804
CAPACITY:6CENSUS: 6DATE:
08/25/2021
UNANNOUNCEDTIME BEGAN:
03:15 PM
MET WITH:Doris Ducre, LicenseeTIME COMPLETED:
05:00 PM
ALLEGATION(S):
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Facility has a foul odor.

Residents are not afforded appropriate sleeping accommodations.
INVESTIGATION FINDINGS:
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On 08/25/2021, at 3:15PM, Licensing Program Analysts (LPAs) L. Hall and L. Holmes arrived unannounced to conduct a complaint investigation and deliver complaint findings. LPAs met with Doris Ducre, Licensee and explained the reason for the visit.

During the course of the investigation, LPAs interviewed five (5) residents and toured the facility including bedrooms, bathroom, and backyard. All six (6) residents share a room. All rooms were fully furnished and had sufficient lighting. LPAs observed a pop-up camper shell in the driveway that was closed down. LPAs observed 2 sheds in the backyard which both were locked. LPAs did not smell any foul odor walking up to or inside the facility.

Continued on LIC9099C.
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Harpreet HumpalTELEPHONE: (510) 285-3928
LICENSING EVALUATOR NAME: Laura HallTELEPHONE: (510) 622-2024
LICENSING EVALUATOR SIGNATURE:

DATE: 08/25/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/25/2021
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 1 of 2
Control Number 15-AS-20200513151512
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1515 CLAY STREET, STE. 310
OAKLAND, CA 94612
FACILITY NAME: DUCRE'S RESIDENTIAL CARE
FACILITY NUMBER: 075601193
VISIT DATE: 08/25/2021
NARRATIVE
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Continued from LIC9099.

Based upon the information obtained during investigation. The above allegations are unsubstantiated. A finding that the complaint is UNSUBSTANTIATED means that although the allegations may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violations occurred.

Exit interview conduct and a copy of the report provided.
SUPERVISOR'S NAME: Harpreet HumpalTELEPHONE: (510) 285-3928
LICENSING EVALUATOR NAME: Laura HallTELEPHONE: (510) 622-2024
LICENSING EVALUATOR SIGNATURE:

DATE: 08/25/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/25/2021
LIC9099 (FAS) - (06/04)
Page: 2 of 2