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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 079200380
Report Date: 07/26/2024
Date Signed: 07/26/2024 10:54:10 AM

Document Has Been Signed on 07/26/2024 10:54 AM - 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:ELISABETH CARE HOMEFACILITY NUMBER:
079200380
ADMINISTRATOR/
DIRECTOR:		OBED D'AUTRUCHEFACILITY TYPE:
740
ADDRESS:1612 N MARTA DRIVETELEPHONE:
(925) 471-0671
CITY:PLEASANT HILLSTATE: CAZIP CODE:
94523
CAPACITY: 4CENSUS: 2DATE:
07/26/2024
TYPE OF VISIT:POCUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:00 AM
MET WITH:Obed & Magadala D'Autruche, LicenseesTIME VISIT/
INSPECTION COMPLETED:
11:00 AM
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On 07/26/2024, at 9:00 AM, Licensing Program Analysts (LPAs) L. Alexander and L. Holmes arrived unannounced to conduct Proof of Correction (POC) visit. LPAs met with Licensees/Administrator, Obed & Magadala D'Autruche and explained the purpose of the visit.

LPAs toured the entire facility including all bedrooms, bathrooms and garage. Licensees were cited and assessed immediate civil penalties on 07/17/2024 for CCR 87355(e). LPAs did not observe any additional individuals at the facility that weren't associated in Guardian. Magadala e-mailed LPA on 07/18/2024 to advise that her family relatives were removed from the facility and are no longer residing at the facility.

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: 07/26/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/26/2024
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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