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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 079200360
Report Date: 01/30/2024
Date Signed: 01/30/2024 03:36:54 PM

Document Has Been Signed on 01/30/2024 03:36 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
E BAY DELTA AC/SC, 1515 CLAY STREET, STE. 310
OAKLAND, CA 94612
FACILITY NAME:TELECARE HOPE HOUSEFACILITY NUMBER:
079200360
ADMINISTRATOR:GARCIA, DENISE GFACILITY TYPE:
772
ADDRESS:300 ILENE STREETTELEPHONE:
(925) 313-7980
CITY:MARTINEZSTATE: CAZIP CODE:
94553
CAPACITY: 16CENSUS: 13DATE:
01/30/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
02:30 PM
MET WITH:Clearnise Bullard, AdministratorTIME COMPLETED:
03:15 PM
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On 01/30/2024 at 2:30PM Licensing Program Analyst (LPA) L. Alexander arrived unannounced to conducted a case management visit as a result of an incident involving an AWOL of a client. The incident occurred on 01/10/2024 and was reported to CCL on 01/11/2024. LPA met with Administrator, Clearnise Bullard and explained the purpose of the visit.

The Administrator stated that C1 was admitted on 01/09/2024 and left the facility on 01/10/2024. Administrator stated that C1 left out the door on the second floor and during routine checks C1 was discovered missing. Administrator stated that staff checked all around the facility including the outside grounds and C1 was not to be found. Administrator stated that C1 is not conserved so she didn't call the police.

C1's physician's report indicates that C1 is able to leave the facility unassisted.

During today's visit, C1's file was reviewed and C1 has still not returned back to the facility.

No deficiencies cited during visit. Exit interview conducted and a copy of this report provided.
Bennett Fong
Lori Alexander-Washington
DATE: 01/30/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/30/2024
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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