Senior Care Records.

Facility Evaluation Report

Humucare INC - Fieldcrest Ave, Fairfield07/09/2025Licence 486804214

Capacity4
Census1
Date signed07/09/2025 02:40:46 PM
Name of licensing program analystAli Deniz
Name of licensing program managerVictoria Bertozzi
The inspector’s account

On 07/09/2025 at approximately 09:25am Licensing Program Analysts (LPA) Deniz conducted an unannounced case management inspection to this facility and was greeted by licensee Olukemi Kuku. LPA following up on information regarding changes to the administration. Licensee failed to notify CCL about change of administrator. However licensee have her administrator certificate. Per conversation with licensee, Administrator Barrett Adams is no longer working in the facility and no longer associated with the facility. Licensee stated that she will submit her documents to CCL to change the administrator under her name.

During today's visit, LPA also discussed to submitting documents in timely manner to CCL. Delays may result another citation or civil penalty.

LPA is requesting documentation regarding a change of administrator to be submitted to CCL by due date 07/19/2025:

LIC 308 Designation of Facility responsibility (designation of who is the administrator)

Administrator Resume (in small facilities if possible)

LIC 503 Health Screening Report - personnel (keep on facility staff file to be reviewed)

TB test that shows "negative" (keep on facility staff file to be reviewed)

LIC 9182 Criminal Record Exemption Transfer Request

No citations issued during today's inspection. Exit interview conducted with Administrator and copy of the report was given.

Source: California Department of Social Services, Community Care Licensing. Methodology · Report a correction