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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 079200774
Report Date: 02/01/2023
Date Signed: 02/01/2023 09:40:49 AM

Document Has Been Signed on 02/01/2023 09:40 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
CCLD Regional Office, 1515 CLAY STREET, STE. 310
OAKLAND, CA 94612
FACILITY NAME:HODGES CARE HOME #3FACILITY NUMBER:
079200774
ADMINISTRATOR:HODGES-WATSON, MYAFACILITY TYPE:
735
ADDRESS:2986 GILMATELEPHONE:
(510) 283-5309
CITY:RICHMONDSTATE: CAZIP CODE:
94806
CAPACITY: 6CENSUS: DATE:
02/01/2023
TYPE OF VISIT:CollateralUNANNOUNCEDTIME BEGAN:
09:05 AM
MET WITH:Pia Webster, Administrator of Webster ITIME COMPLETED:
09:45 AM
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On 1/2/2023 at 9:05AM, Licensing Program Analyst (LPA) C. Fowler arrived announced to conduct a collateral visit to interview one resident. LPA met with Licensee, Pia Webster.

LPA is investigating a complaint pertaining to resident's prior ARF (Adult Residential Facility).


Exit interview conducted and a copy of this report provided.
SUPERVISORS NAME: Bennett Fong
LICENSING EVALUATOR NAME: Carol Fowler
LICENSING EVALUATOR SIGNATURE: DATE: 02/01/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/01/2023
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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