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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 075601374
Report Date: 09/20/2022
Date Signed: 09/20/2022 03:24:02 PM


Document Has Been Signed on 09/20/2022 03:24 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:RED MAPLE RESIDENTIAL HOMEFACILITY NUMBER:
075601374
ADMINISTRATOR:HELEN GRACE HERBERTFACILITY TYPE:
740
ADDRESS:7100 MANILA AVENUETELEPHONE:
(510) 778-9084
CITY:EL CERRITOSTATE: CAZIP CODE:
94530
CAPACITY:6CENSUS: 5DATE:
09/20/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
12:50 PM
MET WITH:Helen Grace Herbert, Licensee and Araceli Emerick, Co-Administrator TIME COMPLETED:
01:15 PM
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On 09/20/22 at 12:50 PM, Licensing Program Analyst (LPA) L. Holmes arrived unannounced to conduct a Pre-Licensing Inspection for a Change of Ownership (CHOW). LPA was greeted by one Care Staff upon entry and explained the purpose of the visit. Helen Grace Herbert, Licensee and Araceli Emerick, Co-Administrator (Co-ADM) arrived about 5 minutes later.

Exit interview conducted and a copy of this report to Helen Grace Herbert, Licensee and Araceli Emerick, Co-Administrator.
SUPERVISOR'S NAME: Yvonne Flores-LariosTELEPHONE: (510) 286-0517
LICENSING EVALUATOR NAME: Lisha HolmesTELEPHONE: 510-286-4201
LICENSING EVALUATOR SIGNATURE:
DATE: 09/20/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/20/2022
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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