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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 079201026
Report Date: 04/22/2022
Date Signed: 04/28/2022 09:46:30 AM

Document Has Been Signed on 04/28/2022 09:46 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:JAMIE'S HOUSEFACILITY NUMBER:
079201026
ADMINISTRATOR:BILLECI-SPIKES, MELISSAFACILITY TYPE:
735
ADDRESS:110 DE NORMANDIE WAYTELEPHONE:
(925) 826-9476
CITY:MARTINEZSTATE: CAZIP CODE:
94553
CAPACITY: 4CENSUS: 0DATE:
04/22/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:10 AM
MET WITH:James McLennanTIME COMPLETED:
10:00 AM
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On 04/22/2022 at 10:35 am, Licensing Program Analyst (LPA) C. Fowler arrived unannounced to conduct an Infection Control Inspection, however the facility was vacant. LPA was able to communicate with Licensee James McLennan who informed LPA that the facility is vacant and he is working with RCEB to get venderized.

On 04/28/2022 at 9:10am Licensing Program Analysts (LPAs) C. Fowler arrived unannounced to conduct infection control inspection LPA's met with Licensee, James McLennan and explained the purpose of the visit

During the Infection Control Inspection, LPAs toured facility including but not limited to common areas, kitchen, bedroom, and shared bathrooms. to front entrance, screening station, hand washing stations, common areas. There is one central entry point for universal screening for staff, residents and visitors. A sign-in policy, thermometer and hand sanitizer were observed at screening station. Cough/sneeze etiquette, social distancing signs were posted in common areas. Hand washing posters, soap, and paper towel were observed at hand washing stations. Visitors policy is posted on the front door. Facility staff was observed wearing a mask. Facility has a 30-day supply of PPE maintained at a central location and easily accessible for staff.

No deficiencies cited during visit.

Exit interview conducted and a copy of this report provided.

SUPERVISORS NAME: Bennett Fong
LICENSING EVALUATOR NAME: Carol Fowler
LICENSING EVALUATOR SIGNATURE: DATE: 04/22/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/22/2022
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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