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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 079200363
Report Date: 02/09/2023
Date Signed: 02/09/2023 03:03:45 PM

Document Has Been Signed on 02/09/2023 03:03 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:
02/09/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
01:10 PM
MET WITH:Mya Hodges-Watson, LicenseeTIME COMPLETED:
03:15 PM
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On 02/09/23 at 01:10 PM, Licensing Program Analyst (LPA) L. Holmes conducted an unannounced annual infection control inspection. LPA met with Licensee, Mya Hodges-Watson and informed her of the purpose of the visit.

The facility had one (1) client present. The facility's Infection Control and Mitigation Plan are on file. Routine symptom screening and temperature checks are done for all staff, residents and visitors; 100% are boosted and vaccinated. An isolation cart, thermometer, masks, gloves, and hand sanitizer are readily available. 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 2 days of non-perishables and 7 days of perishable foods. Fire extinguisher observed fully charged and last inspected 10/03/2022. The facility's temperature was observed at 73 degree Fahrenheit (F). Two first aid kits were present and stocked.

The following forms are to be updated and submitted to CCLD:
-LIC500 Personnel Report (Received staff roster)
-LIC308 Designation of Administrative Responsibility
-LIC610 Emergency Disaster Plan (Reviewed and to be updated)
-An updated copy of Administrator Certificate(s) (Received)

Exit interview conducted and a copy of this report provided.
SUPERVISORS NAME: Yvonne Flores-Larios
LICENSING EVALUATOR NAME: Lisha Holmes
LICENSING EVALUATOR SIGNATURE: DATE: 02/09/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/09/2023
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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