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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 079200990
Report Date: 11/16/2021
Date Signed: 11/16/2021 10:33:43 AM

Document Has Been Signed on 11/16/2021 10:33 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:B & B RESIDENTIAL CARE HOMEFACILITY NUMBER:
079200990
ADMINISTRATOR:UNKNOWNFACILITY TYPE:
735
ADDRESS:320 RIPLEY AVETELEPHONE:
(707) 332-5920
CITY:RICHMONDSTATE: CAZIP CODE:
94801
CAPACITY: 6CENSUS: 0DATE:
11/16/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
08:55 AM
MET WITH:Cheryl Smith, AdministratorTIME COMPLETED:
10:45 AM
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On 11/16/2021 starting at 8:55 AM, Licensing Program Analyst (LPA) Catherine Lin arrived announced to conduct Infection Control Inspection. Facility has not been having client since it was licensed. LPA met with Administrators Cheryl Smith and Erskine Benfrod, and explained the purpose of the visit.

Upon entry, LPA toured facility including but not limited to front entrance, hand washing stations, bedrooms, bathroom, kitchen, common areas, and outdoor areas. There is one central entry point for universal screening for staff, residents, and visitors. Hand washing posters were observed. Facility staff were observed to be wearing proper PPE.

Facility has a sufficient 2-day perishable and one-week non-perishable food supply. Facility has PPEs supplies maintained at central location. Facility has Mitigation Plan and Emergency Disaster Plan on file.

No deficiency cited during visit. Exit interview conducted and a copy of this report provided.
SUPERVISORS NAME: Bennett Fong
LICENSING EVALUATOR NAME: Catherine Lin
LICENSING EVALUATOR SIGNATURE: DATE: 11/16/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/16/2021
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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