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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 079200977
Report Date: 08/12/2022
Date Signed: 08/12/2022 09:55:27 AM

Document Has Been Signed on 08/12/2022 09:55 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:WE CARE ELDERLY CAREFACILITY NUMBER:
079200977
ADMINISTRATOR:WHITE, BRITTANY DFACILITY TYPE:
740
ADDRESS:4155 BELL AVETELEPHONE:
(510) 375-4460
CITY:RICHMONDSTATE: CAZIP CODE:
94804
CAPACITY: 8CENSUS: 5DATE:
08/12/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
08:45 AM
MET WITH:Administrator, Brittany WhiteTIME COMPLETED:
10:00 AM
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On 08/12/22 at 8:45 AM, Licensing Program Analyst (LPA) L. Holmes arrived unannounced to conduct a case management visit. LPA was greeted by Staff #2 (S2). LPA explained the reason for the visit and contacted Administrator (ADM) Brittany White who said she'd arrive in about 30-45 minutes.

LPA went to the facility to deliver an immediate exclusion letter and to verify S1 is not working at the facility. LPA spoke to ADM and she stated that the Licensee was working with some people to get cleared, but S1 does not work at the facility. LPA entered the facility and verified that S1 was not working. LPA delivered the documented letter(s) to ADM.

No deficiencies cited on this date.

Exit interview conducted. A copy of this report provided to ADM.
SUPERVISORS NAME: Yvonne Flores-Larios
LICENSING EVALUATOR NAME: Lisha Holmes
LICENSING EVALUATOR SIGNATURE: DATE: 08/11/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/11/2022
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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