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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 019200464
Report Date: 11/07/2023
Date Signed: 11/07/2023 03:16:39 PM


Document Has Been Signed on 11/07/2023 03:16 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:J & C CARE CENTER LLCFACILITY NUMBER:
019200464
ADMINISTRATOR:CHING, JESSICAFACILITY TYPE:
740
ADDRESS:4240 REDDING STREETTELEPHONE:
(510) 482-0108
CITY:OAKLANDSTATE: CAZIP CODE:
94619
CAPACITY:25CENSUS: 17DATE:
11/07/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:45 AM
MET WITH:CHING JESSICA, ADMINISTRATORTIME COMPLETED:
03:35 PM
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On 11/07/2023 at 10:35 AM, Licensing Program Analyst (LPA) K. Nguyen arrived unannounced to conduct 1-Year Annual Required inspection. LPA met with Jessica Ching, Administrator and explained the purpose of the visit.

LPA toured facility with Jessica including but not limited to bedrooms, bathrooms, kitchen, common area and backyard. The facility consists of 14 total bedrooms which 12 bedrooms are occupied by the residents and 0 bedroom is occupied by staff. All outdoor and indoor passageways are kept free of obstruction. There are no bodies of water observed. A comfortable temperature is maintained at 70 degrees Fahrenheit. LPA observed lighting in all rooms are adequate for the comfort and safety of the residents. The hot water temperature in the residents’ shared bathroom was measured at 110.9 degrees Fahrenheit. Residents’ bathrooms are equipped with grab bars and non-skid tiles. There is a minimum of one week supply of nonperishable and 2-day of perishable foods. Centrally stored medication and sharps were locked and inaccessible to residents.

Smoke detectors and carbon monoxide detectors were in operating condition during visit. Fire extinguisher was last serviced on 11/2/2023. Emergency Disaster Plan was last posted on 1/1/2018. First aid kit was observed to be complete. Emergency disaster drill was last conducted on 11/02/2023.

LPA reviewed 4 residents records. LPA reviewed 4 staff records and 4 of 4 have current first aid training and associated to the facility. LPA reviewed a sample of resident’s medications.

No deficiencies cited during visit. Exit interview conducted and a copy of this report provided via email.

SUPERVISOR'S NAME: Bennett FongTELEPHONE: (510) 725-7919
LICENSING EVALUATOR NAME: Kelly NguyenTELEPHONE: (510) 915-8702
LICENSING EVALUATOR SIGNATURE:
DATE: 11/07/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/07/2023
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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