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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 079200360
Report Date: 09/25/2024
Date Signed: 09/25/2024 12:44:46 PM

Document Has Been Signed on 09/25/2024 12:44 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
E BAY DELTA AC/SC, 1515 CLAY STREET, STE. 310
OAKLAND, CA 94612
FACILITY NAME:TELECARE HOPE HOUSEFACILITY NUMBER:
079200360
ADMINISTRATOR/
DIRECTOR:		BULLARD, CLEARNISEFACILITY TYPE:
772
ADDRESS:300 ILENE STREETTELEPHONE:
(925) 313-7980
CITY:MARTINEZSTATE: CAZIP CODE:
94553
CAPACITY: 16CENSUS: 12DATE:
09/25/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
11:35 AM
MET WITH:Clearnise Bullard, AdministratorTIME VISIT/
INSPECTION COMPLETED:
12:50 PM
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On 09/25/2024 at 11:35 AM Licensing Program Analysts (LPAs) L. Alexander and L. Holmes arrived unannounced to conducted a case management visit as a result of an incident involving an AWOL of a client. The incident occurred on 09/06/2024 and was reported to CCL on 09/06/2024. LPAs met with Administrator, Clearnise Bullard and explained the purpose of the visit.

LPAs interviewed S1 that stated C1 left the facility at around 7:00 AM. S1 stated that S2 saw C1 walking down Alice Street. S1 stated that C1 returned back to the facility at around 10 AM and that they observed C1 to be sweaty and disoriented. S1 stated that C1 told one of his peers in Spanish that someone pulled a gun on him while he was gone. S1 stated that S3 came outside to where C1 was sitting on the bench and that S4 came outside to take C1's vitals. S1 stated that C1 asked for them to call 911. S1 stated that the paramedics arrived and transported C1 to Contra Costa Regional Medical Center (CCRMC). S1 stated that C1 was evaluated at CCRMC and tested positive for marijuana and amphetamine. S1 stated that C1 was discharged from CCRMC and returned back to the facility in about 3 hours. S1 stated that they put in place "Q30 hold stay" which is when the Residential Counselors (RC) check on a client every 30 minutes. C1's physician's report indicates that C1 is able to leave the facility unassisted.

During today's visit, C1's file was reviewed and C1 was discharged from the facility on 09/13/2024.

No deficiencies cited during visit. Exit interview conducted and a copy of this report provided.
SUPERVISORS NAME: Bennett Fong
LICENSING EVALUATOR NAME: Lori Alexander-Washington
LICENSING EVALUATOR SIGNATURE: DATE: 09/25/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/25/2024
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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