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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 079200363
Report Date: 03/09/2022
Date Signed: 03/09/2022 02:17:53 PM

Document Has Been Signed on 03/09/2022 02:17 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:HODGES CARE HOMEFACILITY NUMBER:
079200363
ADMINISTRATOR:BRITTINI REDDITTFACILITY TYPE:
735
ADDRESS:2624 VIRGINIA AVENUETELEPHONE:
(510) 232-4046
CITY:RICHMONDSTATE: CAZIP CODE:
94804
CAPACITY: 6CENSUS: 5DATE:
03/09/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
12:35 PM
MET WITH: Licensee, Mya Hodges-WatsonTIME COMPLETED:
02:25 PM
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03/09/22 at 12:35 PM, Licensing Program Analyst (LPA) L. Holmes conducted an unannounced infection control annual inspection. LPA met with Licensee, Mya Hodges-Watson and informed her of the purpose of the visit.

The facility had (2) two additional care staff and (5) five clients present. The facility's COVID-19 mitigation plan is on file.

LPA started the inspection with care staff, Syliva Ford. Mya was at the facility on a zoom call. LPA observed a screening station located at the entrance with a visitor's log, thermometer, masks, gloves, and hand sanitizer. Routine symptom screening and temperature checks are done for all staff, residents and visitors. Residents are screened for COVID-19 symptoms and temperatures upon return from daily outings also.

An adequate supply of centrally stored PPEs were observed in the back room. There were at least 7 days of non-perishables and 2 days of perishable foods. Fire extinguisher observed fully charged and showed last inspected on 10/04/2021. First aid kit present and stocked.

LPA observed the following:
1. 20 seconds handwashing signs in general area for kitchen and bathroom due to level of clients.

LPA recommended the following:
1. Add covered garbage cans to bathrooms 1 and 2.
2. Remove towels after each use in the bathrooms.
3. Create an isolation cart for isolation room.
SUPERVISORS NAME: Yvonne Flores-Larios
LICENSING EVALUATOR NAME: Lisha Holmes
LICENSING EVALUATOR SIGNATURE: DATE: 03/09/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/09/2022
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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