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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 496802021
Report Date: 04/12/2024
Date Signed: 04/12/2024 10:42:17 AM

Document Has Been Signed on 04/12/2024 10:42 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, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405
FACILITY NAME:B&J CHARNING CROSSFACILITY NUMBER:
496802021
ADMINISTRATOR/
DIRECTOR:		ZHENG, JUN JIFACILITY TYPE:
735
ADDRESS:1008 CHARNING CROSS LANETELEPHONE:
(707) 546-4208
CITY:SANTA ROSASTATE: CAZIP CODE:
95401
CAPACITY: 6CENSUS: 4DATE:
04/12/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:36 AM
MET WITH:JJ Zheng (Licensee/Administrator)TIME VISIT/
INSPECTION COMPLETED:
10:57 AM
NARRATIVE
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Licensing Program Analyst (LPA) Cuadra arrived unannounced to conduct an Annual Required inspection and met with Licensee/Administrator, JJ Zheng. Clients were attending to day program during visit.

LPA/Licensee initiated a tour of the facility at 8:50 am and observed the following. Facility was a comfortable temperature and passageways were free from obstructions. Client rooms are furnished per regulation. Extra linens and hygiene products are available. Water temperature in client bathrooms read at 108.1 which are within regulation of 105 and 120 degrees F. At least two days of perishable and one week of non-perishable foods were available. Surplus perishable and non-perishable food is stored in the garage. Toxins were inspected and are stored in a locked cabinet in the garage. Cash resources reviewed. Fire extinguishers were last inspected November 2023. Facility has a fire pull system. Smoke detectors and carbon monoxide detector located throughout the facility were tested and operational. Last disaster drill was conducted on February 2024. Administrator had outstanding fees in the amount of $454, but they provided receipt of payment to LPA. LPA confirmed payment received at CCL. Medication and their records were reviewed.

File review initiated at 9:15am. Four client files and three staff files were reviewed. All staff have current CPR/1st aid on file and required training hours completed. Administrator certificate for administrator JJ Zheng #6030306735 expired on 1/8/2023. The Licensee is also current Administrator, however their Administrator certificate is neither active nor pending. Administrator could not provide proof that they submitted required documentation to the certification unit to obtain a current certificate.

Licensee/Administrator to submit updates of the following documents by 4/19/24: Personnel Report (LIC500), Emergency Disaster Plan (LIC610E), Surety Bond and Control of Property (Deed, property tax, etc).

Deficiencies cited from the California Code of Regulations, Title 22, Division 6 of California Regulation. Appeal rights given. Failure to correct the deficiency and/or repeat deficiencies within a 12 month period may result in civil penalties. Exit interview conducted with Licensee and copy of this report was given.
SUPERVISORS NAME: Bethany Moellers
LICENSING EVALUATOR NAME: Marisol Cuadra
LICENSING EVALUATOR SIGNATURE: DATE: 04/12/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/12/2024
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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Document Has Been Signed on 04/12/2024 10:42 AM - It Cannot Be Edited


Created By: Marisol Cuadra On 04/12/2024 at 10:28 AM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405

FACILITY NAME: B&J CHARNING CROSS
FACILITY NUMBER: 496802021

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/12/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
85064(b)
Administrator Qualifications and Duties
(b) All adult residential facilities shall have a qualified and currently certified administrator.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on LPA interview and record review, the licensee did not comply with the section cited above in that the Licensee is also current Administrator, however their Administrator certificate is neither active nor pending, which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 04/19/2024
Plan of Correction
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The Licensee will submit required documentation to the Certification Unit to process their certificate. Licensee agreed to submit proof of documentation submitted to Certification Unit and written plan indicating plan for implementation and start date of qualified and certified administrator. Plan to be submitted to CCL LPA by POC due date to clear the citation.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Bethany Moellers
LICENSING EVALUATOR NAME:Marisol Cuadra
LICENSING EVALUATOR SIGNATURE:
DATE: 04/12/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/12/2024


LIC809 (FAS) - (06/04)
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