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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 079200205
Report Date: 03/12/2025
Date Signed: 03/12/2025 02:11:18 PM

Document Has Been Signed on 03/12/2025 02:11 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
OAKLAND ASC, 1515 CLAY STREET, STE. 310
OAKLAND, CA 94612
FACILITY NAME:CROW CANYON RESIDENTIAL CARE 1FACILITY NUMBER:
079200205
ADMINISTRATOR/
DIRECTOR:		RUFFY B. YUFACILITY TYPE:
735
ADDRESS:47 BIGELOW PLACETELEPHONE:
(925) 361-5285
CITY:SAN RAMONSTATE: CAZIP CODE:
94583
CAPACITY: 6CENSUS: 6DATE:
03/12/2025
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
12:00 PM
MET WITH:House Manager, Den LuzonTIME VISIT/
INSPECTION COMPLETED:
02:30 PM
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On 3/28/2024 at 12:45PM, Licensing Program Analyst (LPA) A. Gomez arrived unannounced to conduct 1-Year Annual Required inspection. LPA met with House Manager, Den Luzon and explained the purpose of the visit. The facility’s fire clearance was approved for 6 and 4 may be non-ambulatory. Most clients were away at the day program.

LPA toured the facility with House Manager including but not limited to bedrooms, bathrooms, kitchen, common area and backyard. The facility consists of 5 total bedrooms which 4 bedrooms are occupied by the clients and 1 bedroom is occupied by staff. All outdoor and indoor passageways are kept free of obstruction. There are no bodies of water. A comfortable temperature for clients is maintained at 70 degree Fahrenheit. LPA observed lighting in all rooms are adequate for the comfort and safety of the clients. Hot water temperature in the shared clients’ bathroom was measured in bathrooms between 105 and 120 degree Fahrenheit. All toilets, hand washing and bathing are safe, sanitary and in operating condition. The supply of extra hygienes were available for clients. There is a minimum of one week supply of non-perishables and 2-day perishables food supply.

Smoke detectors and carbon monoxide were in operating condition during visit. Fire extinguisher was last serviced on 2/10/2025. Emergency Disaster Plan last reviewed 3/12/2025. First aid kit was observed to be complete. Fire drill was last conducted on 2/17/2025. PNI correct and complete. Surety Bond is enough to cover PNI.

At 12:30pm, 5 of 6 clients records were reviewed. At 1:20pm, 3 staff records were reviewed and 3 of 3 have current first aid training and associated to the facility.


No deficiencies cited during visit. Exit interview conducted and a copy of this report provided.
SUPERVISORS NAME: Yvonne Flores-Larios
LICENSING EVALUATOR NAME: Alona Gomez
LICENSING EVALUATOR SIGNATURE: DATE: 03/12/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/12/2025
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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