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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 079200104
Report Date: 12/05/2023
Date Signed: 12/05/2023 01:20:53 PM

Document Has Been Signed on 12/05/2023 01:20 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: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: 28DATE:
12/05/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Cheryl Reed Program CoordinatorTIME COMPLETED:
02:00 PM
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On 12/5/2023 at 9:30am, Licensing Program Analyst (LPA) Carol Fowler arrived unannounced to conduct an Annual 1-year required inspection. LPA met with Cheryl Reed, Program Coordinator, and explained the reason for the visit. The facility's fire clearance was approved for 60 ambulatory, 30 non-ambulatory and 10 bedridden.

LPA inspected the facility with Program Coordinator, which included but not limited to the bathrooms, kitchen, common areas, and the outside area of the facility. LPA observed the facility to be free of odor, clean and in good repair. Outdoor space is provided and is free of hazards. There is a comfortable room temperature of 73 degrees Fahrenheit for clients in care. Clients bring their own lunches and snacks to facility. The hot water temperature in the shared bathroom measured 120.0 degrees. All observed toilets and hand washing stations are maintained in a safe, sanitary, operating condition. There are no bodies of water or fire safety hazards observed. Carbon monoxide and smoke fire alarms found to be in working order. Centrally stored medications, toxins and sharp objects were locked and inaccessible to participants. Fire extinguisher last services 10/19/2023. Fire drills are conducted once a month. First aid kit was checked and is complete.

LPA reviewed four (4) staff files and all have current first aid & CPR certification. LPA reviewed nine (9) participants and all were current and complete.

Continued on LIC809C.
SUPERVISORS NAME: Bennett Fong
LICENSING EVALUATOR NAME: Carol Fowler
LICENSING EVALUATOR SIGNATURE: DATE: 12/05/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/05/2023
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		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 - RICHMOND
FACILITY NUMBER: 079200104
VISIT DATE: 12/05/2023
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Continued from LIC809.

The following forms to be updated and submitted to CCLD by 12/15/2023:

· LIC 308 Designation of Administrative Responsibility
· LIC 610D Emergency Disaster Plan

No deficiencies were cited during this inspection.

Exit interview conducted and a copy of this report provided.
SUPERVISORS NAME: Bennett Fong
LICENSING EVALUATOR NAME: Carol Fowler
LICENSING EVALUATOR SIGNATURE:

DATE: 12/05/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/05/2023
LIC809 (FAS) - (06/04)
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