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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 079200302
Report Date: 07/14/2021
Date Signed: 07/14/2021 11:27:58 AM

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:STUART HOUSE, THEFACILITY NUMBER:
079200302
ADMINISTRATOR:PAMELA GREENFACILITY TYPE:
740
ADDRESS:3067 BELFAST WAYTELEPHONE:
(510) 262-0206
CITY:RICHMONDSTATE: CAZIP CODE:
94806
CAPACITY:6CENSUS: 3DATE:
07/14/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:45 AM
MET WITH:Pamela Green, AdministratorTIME COMPLETED:
11:35 AM
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On 7/14//2021 at 9:45AM, Licensing Program Analysts (LPAs) L. Hall and C. Fowler arrived unannounced to conduct an Infection Control Inspection. LPAs met with Administrator, Pamela Green and explained the purpose of the visit.

Upon entry, LPAs temperatures were not checked, LPAs observed hand sanitizer, and COVID-19 signage at screening station. LPAs toured facility including but not limited to common areas, bathroom, kitchen, garage, and backyard. All sinks were equipped with soap, paper towel, and hand washing signs.

During record review, LPAs observed visitors log and temperature log for both residents and staff. LPAs observed facility has a copy of Mitigation Plan on file. LPAs observed PPE, food and paper supplies are sufficient.

No deficiencies were cited during this inspection.

Exit interview conducted. A copy of this report provided.
SUPERVISOR'S NAME: Harpreet HumpalTELEPHONE: (510) 285-3928
LICENSING EVALUATOR NAME: Laura HallTELEPHONE: (510) 622-2024
LICENSING EVALUATOR SIGNATURE:

DATE: 07/14/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/14/2021
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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