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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 079200627
Report Date: 07/02/2024
Date Signed: 07/02/2024 04:16:05 PM

Document Has Been Signed on 07/02/2024 04:16 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:DINAMI HOME INCFACILITY NUMBER:
079200627
ADMINISTRATOR/
DIRECTOR:		RIDEOUT, TWYLAFACILITY TYPE:
735
ADDRESS:26 MURILLO COURTTELEPHONE:
(510) 689-9552
CITY:OAKLEYSTATE: CAZIP CODE:
94561
CAPACITY: 6CENSUS: 2DATE:
07/02/2024
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
03:35 PM
MET WITH:TWYLA RIDEOUT, ADMINISTRATORTIME VISIT/
INSPECTION COMPLETED:
04:49 PM
NARRATIVE
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While investigating complaint (15-AS-20240628155848), and upon review of Guardian roster review, Licensing Program Analysts (LPAs) Carol Fowler and Tonica Syess-Gibson learned that staff 1 (S1) was not associated to the facility and did not have access to the client files.

LPAs discussed the above with the House Manager and Administrator.

Deficiency is cited from Title 22 California Code of Regulations and listed on 809D. Failure to submit proof of correction by plan of correction due date and any repeat violation within 12 month period may result in civil penalty.

Deficiency and plan and proof of correction were discussed with the House Manager and Administrator.

Exit interview conducted. Appeal Rights, and copy of this report provided.
SUPERVISORS NAME: Bennett Fong
LICENSING EVALUATOR NAME: Carol Fowler
LICENSING EVALUATOR SIGNATURE: DATE: 07/02/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/02/2024
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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Document Has Been Signed on 07/02/2024 04:16 PM - It Cannot Be Edited


Created By: Carol Fowler On 07/02/2024 at 03:47 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 1515 CLAY STREET, STE. 310
OAKLAND, CA 94612

FACILITY NAME: DINAMI HOME INC
FACILITY NUMBER: 079200627

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/02/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
07/09/2024
Section Cited
CCR
87355(e)(2)

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e) All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1569.17(b) shall prior to working, residing or volunteering in a licensed facility: (2) Request a transfer of a criminal record clearance as specified in Section 87355(c) or....
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Administrator agreed to always check the Guardian Roster to ensure new staff has been associated. DEFICIENCY WAS CLEARED DURING VISIT.
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This requirement is not met as evidenced by: Based on observation and record review, the licensee did not comply with the section cited above in having S1 associated to the facility which poses an immediate health, safety or personal rights risk to persons in care.
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Type B
07/09/2024
Section Cited
CCR80070(d)

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d) All client records shall be available to the licensing agency to inspect, audit, and copy upon demand during normal business hours. Records may be removed if necessary for copying. Removal of records shall be subject to the following requirements:
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Administrator agreed to have records available to staff at all times. DEFICIENCY WAS CLEARED DURING VISIT.
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This requirement is not met as evidenced by: Based on observation the Administrator did not comply with the section cited above in having client records inaccessible to staff.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Bennett Fong
LICENSING EVALUATOR NAME:Carol Fowler
LICENSING EVALUATOR SIGNATURE:
DATE: 07/02/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/02/2024


LIC809 (FAS) - (06/04)
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