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Department of
SOCIAL SERVICES
Community Care Licensing
FACILITY EVALUATION REPORT
Facility Number:
079201328
Report Date:
09/05/2024
Date Signed:
09/05/2024 11:34:19 AM
Document Has Been Signed on
09/05/2024 11:34 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:
GREEN PASTURES RESIDENTIAL CARE HOMES
FACILITY NUMBER:
079201328
ADMINISTRATOR:
BOND, RICHARD
FACILITY TYPE:
740
ADDRESS:
3033 BIRMINGHAM DRIVE
TELEPHONE:
(510) 847-0271
CITY:
RICHMOND
STATE:
CA
ZIP CODE:
94806
CAPACITY:
6
CENSUS:
0
DATE:
09/05/2024
TYPE OF VISIT:
Case Management - Other
UNANNOUNCED
TIME BEGAN:
11:25 AM
MET WITH:
Richard Bond Administrator
TIME COMPLETED:
11:40 AM
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An announced Pre-licensing Comp III associated with Pre-Licensing Inspection done on 09/05/2024 at 11:25 AM was conducted by Licensig Program Analysts (LPAs) Carol Fowler and David Doidge. Comp III was attended by Richard Bond Administrator.
LPAs discussed the power point after which LPAs observed Licensee Richard Bond with a better and clear understanding of Title 22 regulations and Community Care Licensing in general.
LPAs concluded Comp III.
No citation made during this visit. Exit interview conducted and a copy of this report provided.
SUPERVISOR'S NAME:
Bennett Fong
TELEPHONE:
(510) -62-2621
LICENSING EVALUATOR NAME:
Carol Fowler
TELEPHONE:
(510) 622-2715
LICENSING EVALUATOR SIGNATURE:
DATE:
09/05/2024
I acknowledge receipt of this form and understand my
licensing
appeal rights as
explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE:
09/05/2024
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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