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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 079200965
Report Date: 05/20/2024
Date Signed: 05/20/2024 03:32:47 PM

Document Has Been Signed on 05/20/2024 03:32 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
OAKLAND ASC, 1515 CLAY STREET, STE. 310
OAKLAND, CA 94612
FACILITY NAME:J AND R HOME CARE LLCFACILITY NUMBER:
079200965
ADMINISTRATOR/
DIRECTOR:		TANG, RENEEFACILITY TYPE:
735
ADDRESS:773 SARAH STREETTELEPHONE:
(925) 634-8863
CITY:BRENTWOODSTATE: CAZIP CODE:
94513
CAPACITY: 5CENSUS: 3DATE:
05/20/2024
TYPE OF VISIT:Case Management - Health ChecksUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
02:30 PM
MET WITH:LIza Capio, Caregiver TIME VISIT/
INSPECTION COMPLETED:
03:45 PM
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On 05/20/2024 at 2:30PM, Licensing Program Analyst (LPA) T.Syess-Gibson conducted a Health & Safety inspection as a result of client relocating. LPA met with caregiver, Liza Capio and explained purpose of visit. Caregiver Liza contacted Administrator via telephone. House manager Joy Bisaha arrived at 3:05PM, LPA explained the purpose of the visit.

Upon arrival, LPA observed total of two (2)staff(S1, and S2)and three (3) clients(C1, C2, and C3) home during visit. LPA toured facility including but not limited to the bedrooms, bathrooms, common area, kitchen. Hot water temperature was measured at 125.5 degrees Fahrenheit in the common bathroom. Facility is maintained at a comfortable temperature of 74 degrees Fahrenheit for the clients in care. 7-days of non-perishable and 2-days of perishable food supplies were observed. Clients in care appear to be safe and there are no imminent health/safety concerns. Facility is noted to be clean and in good repair.

No deficiencies cited during visit. Exit interview conducted and a copy of this report provided.
SUPERVISORS NAME: Harpreet Humpal
LICENSING EVALUATOR NAME: Tonica Syess-Gibson
LICENSING EVALUATOR SIGNATURE: DATE: 05/20/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/20/2024
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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