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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 075601574
Report Date: 02/07/2024
Date Signed: 02/07/2024 02:09:24 PM


Document Has Been Signed on 02/07/2024 02:09 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
OAKLAND ASC, 1515 CLAY STREET, STE. 310
OAKLAND, CA 94612



FACILITY NAME:SANS SOUCIFACILITY NUMBER:
075601574
ADMINISTRATOR:KATHERINE GRUTASFACILITY TYPE:
740
ADDRESS:330 EL DIVISADERO AVENUETELEPHONE:
(925) 949-8475
CITY:WALNUT CREEKSTATE: CAZIP CODE:
94598
CAPACITY:6CENSUS: 5DATE:
02/07/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Annie HonrubiaTIME COMPLETED:
02:30 PM
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On 02/07/2024 at 9:00 AM, Licensing Program Analyst (LPA) James Sampair arrived unannounced to conduct a required annual inspection. LPA explained the purpose of the visit to staff member Nemesio "John" Lopez. The LPA and Administrator (ADM) Katherine Grutas Dunphy spoke over the telephone multiple times during the visit, and her representative Annie Honrubia arrived at approximately 10:15 AM and stayed until the completion of the visit.

The LPA inspected facility inside and out. LPA reviewed files of 5 residents and 5 staff members. There were at least 7 days of nonperishable and 2 days of perishable foods. Temperature in the facility at 12:47 PM was measured at 75.8 degrees in the dining room. Fire extinguisher was fully charged. Carbon monoxide and smoke detectors operational. Administrator is on site a minimum of 20 hours a week to oversee proper business operation.

No citations issued during inspection.

Administrator to send updated copies of these documents to CCL on or before 02/14/2024:
  1. LIC500 - Personnel Report
  2. Evidence of sufficient Liability Insurance

Exit interview conducted with Annie Honrubia and a copy of this report provided via email to ADM.
SUPERVISOR'S NAME: Bennett FongTELEPHONE: (510) -62-2621
LICENSING EVALUATOR NAME: James SampairTELEPHONE: (510) 286-4201
LICENSING EVALUATOR SIGNATURE:
DATE: 02/07/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/07/2024
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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