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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 075601193
Report Date: 04/05/2022
Date Signed: 04/05/2022 11:43:45 AM


Document Has Been Signed on 04/05/2022 11:43 AM - 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: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: 4DATE:
04/05/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:15 AM
MET WITH:Administrator, Doris DucreTIME COMPLETED:
11:45 AM
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On 04/05/2022 at 10:15 AM Licensing Program Analyst (LPA) L. Holmes conducted an unannounced annual inspection. Upon arrival LPA was greeted by Staff, Moris Ducree and began the inspection with Administrator, Doris Ducre.

Facility has completed a COVID-19 mitigation plan and will add COVID-19 screening questionnaire to visitor log. LPA observed two (2) staff and four (4) residents at the facility.

LPA inspected the facility inside and out with Administrator. LPA and Administrator toured facility's kitchen, common areas, residents rooms, and bathroom. The Administrator had at least a 7-day supply of non-perishable foods and 2-days of perishables. Fresh food are purchased weekly. LPA observed COVID-19 signs posted in the common area. Covered trash bins are needed in the kitchen, bathroom, and residents rooms. PPE observed and sufficient. LPA gave advisory in regards to isolation, PPE supply, screening, and mitigation practices. The hot water temperature measured 117.2 degrees Fahrenheit, First Aid kit observed complete, fire extinguisher last inspected 02/04/2022 along with smoke/carbon monoxide detectors.

No deficiencies cited.
Exit interview conducted and a copy of this report provided.
SUPERVISOR'S NAME: Yvonne Flores-LariosTELEPHONE: (510) 286-0517
LICENSING EVALUATOR NAME: Lisha HolmesTELEPHONE: 510-286-4201
LICENSING EVALUATOR SIGNATURE:
DATE: 04/05/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/05/2022
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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