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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 079200523
Report Date: 01/28/2025
Date Signed: 01/28/2025 04:13:49 PM

Document Has Been Signed on 01/28/2025 04:13 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:BRUIZ CAREHOMEFACILITY NUMBER:
079200523
ADMINISTRATOR/
DIRECTOR:		BERNARDINO-RUIZ, JAMIE AFACILITY TYPE:
740
ADDRESS:2353 DEMARTINI LANETELEPHONE:
(925) 634-8802
CITY:BRENTWOODSTATE: CAZIP CODE:
94513
CAPACITY: 6TOTAL ENROLLED CHILDREN: 0CENSUS: 5DATE:
01/28/2025
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
02:08 PM
MET WITH:Brian Llagas, CaregiverTIME VISIT/
INSPECTION COMPLETED:
04:25 PM
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On 01/30/2024 at 2:08PM, Licensing Program Analyst (LPA) T. Syess-Gibson arrived unannounced to conduct Required 1 Year Annual inspection. LPA met with Caregiver, Brian Llagas and explained the purpose of the visit. Administrator, Jamie Bernardino-Ruiz arrived at 2:41PM. The facility’s fire clearance was approved for five (5) non-ambulatory and one (1) bedridden resident.

LPA toured facility with Brian and Jamie including but not limited to bedrooms, bathrooms, kitchen, common area and backyard. The facility consists of seven (7) total bedrooms, one (1) bedroom occupied by staff and two and half (2 1/2) bathrooms. 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 112.1 degrees Fahrenheit. Residents’ bathrooms are equipped with grab bars and non-skid mats. There is a minimum of 7 day 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 12/17/2024. First aid kit was observed to be complete. Fire drill last conducted on 01/05/2025 . Emergency disaster plan updated 12/16/2024.

Continues on LIC809C
Harpreet HumpalTELEPHONE: (510) 285-3928
Tonica Syess-GibsonTELEPHONE: (510) 414-0641
DATE: 01/28/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/28/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 2
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
OAKLAND ASC, 1515 CLAY STREET, STE. 310
OAKLAND, CA 94612
FACILITY NAME: BRUIZ CAREHOME
FACILITY NUMBER: 079200523
VISIT DATE: 01/28/2025
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Continued from LIC809.


Five (5) staff records were reviewed, all five (5) staff were associated and had FirstAid. LPA reviewed all five (5) resident records, and they were complete.


LPA requested the following documents to be submitted to CCLD by 02/04/2025.
  • LIC 308 Designation of Administrative Responsibility
  • LIC 309 Administrative Organization
  • LIC 500 Personnel Report
  • LIC 610E Emergency Disaster Plan (last page)
  • Liability Insurance
  • Updated Facility Sketch


LPA observed no deficiencies during visit.

Exit interview conducted a copy of this report provided.

SUPERVISOR'S NAME: Harpreet HumpalTELEPHONE: (510) 285-3928
LICENSING EVALUATOR NAME: Tonica Syess-GibsonTELEPHONE: (510) 414-0641
LICENSING EVALUATOR SIGNATURE:

DATE: 01/28/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/28/2025
LIC809 (FAS) - (06/04)
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