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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 079201307
Report Date: 12/20/2023
Date Signed: 12/20/2023 02:53:50 PM

Document Has Been Signed on 12/20/2023 02:53 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
CCLD Regional Office, 1515 CLAY STREET, STE. 310
OAKLAND, CA 94612
FACILITY NAME:BEYOND CARE HOMESFACILITY NUMBER:
079201307
ADMINISTRATOR:BERRIS, JEAN C.FACILITY TYPE:
735
ADDRESS:124 MADORA PLACETELEPHONE:
(510) 513-3911
CITY:SAN RAMONSTATE: CAZIP CODE:
94583
CAPACITY: 6CENSUS: 0DATE:
12/20/2023
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
12:45 PM
MET WITH:Berries Jean C., AdminstratorTIME COMPLETED:
02:00 PM
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On 12/20/2023 at 12:45PM, Licensing Program Analyst (LPA) K. Nguyen arrived unannounced to conduct Pre-licensing Inspection. Upon arrival, LPA met with Berries Jean Administrator, and explained the purpose of the visit. The facility currently has no residents.

LPA toured facility including but not limited to 3 bedrooms, 3 bathrooms, kitchen, common areas and backyard. Bedrooms and living rooms were equipped with the proper furniture. Bathrooms were equipped with grab bars and shower seat. Linens and hygiene supplies were observed inside a cabinet. There is sufficient lighting throughout facility. Room temperature was maintained at 66 degrees F and hot water temperature was maintained at 111 degrees F. First-aid kit was observed to be complete. Smoke detectors and carbon monoxide were operational. Fire extinguisher was purchase on 09/28/2023.

No issues noted during inspection. LPAs observed that facility is ready to be licensed. This report will be submitted to the Central Applications Unit (CAU) and a final review of the application will be conducted. This facility is not yet licensed, and is subject to final approval by CAU. Additional requirements may still be required.

Exit interview conducted and a copy of this report provided via email.
SUPERVISORS NAME: Bennett Fong
LICENSING EVALUATOR NAME: Kelly Nguyen
LICENSING EVALUATOR SIGNATURE: DATE: 12/20/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/20/2023
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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