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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 079200104
Report Date: 12/22/2021
Date Signed: 12/22/2021 10:19:15 AM

Document Has Been Signed on 12/22/2021 10:19 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:GEORGE MILLER CENTER - RICHMONDFACILITY NUMBER:
079200104
ADMINISTRATOR:CAROL ANNE MCCRARYFACILITY TYPE:
775
ADDRESS:2801 ROBERT H. MILLER DRIVETELEPHONE:
(510) 222-8266
CITY:RICHMONDSTATE: CAZIP CODE:
94806
CAPACITY: 100CENSUS: 7DATE:
12/22/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Aimee Vitug-Hom, DirectorTIME COMPLETED:
10:30 AM
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On 12/22/2021 at 09:00 AM, Licensing Program Analyst (LPA) C. Fowler arrived unannounced to conduct 1-Year Annual Required inspection. LPA met with Program Director, Aimee Vitug-Hom and explained the purpose of the visit. Day program operates from 9:30 AM to 1:00 PM. There were 4 staff observed working with the 7 clients here today.

LPA toured facility with Aimee-Vitug-Hom including but not limited to, multiple activity rooms, kitchen, bathrooms, office space. Clients bring their own lunches and snacks. Emergency supplies, including water were observed. Cleaning supplies are locked and inaccessible to clients. Medications are not handled/dispensed by this program at this time. There are no bodies of water or fire safety hazards observed. Restrooms are maintained in safe and in sanitary operating condition.
SUPERVISORS NAME: Bennett Fong
LICENSING EVALUATOR NAME: Carol Fowler
LICENSING EVALUATOR SIGNATURE: DATE: 12/22/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/22/2021
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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