<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 011400627
Report Date: 11/09/2022
Date Signed: 11/09/2022 05:04:15 PM


Document Has Been Signed on 11/09/2022 05:04 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:ST. PAUL'S TOWERSFACILITY NUMBER:
011400627
ADMINISTRATOR:YUEN, CONNIEFACILITY TYPE:
741
ADDRESS:100 BAY PLACETELEPHONE:
(510) 835-4700
CITY:OAKLANDSTATE: CAZIP CODE:
94610
CAPACITY:320CENSUS: 231DATE:
11/09/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
03:50 PM
MET WITH:Angela Zamarripa, Resident Health Services Director TIME COMPLETED:
05:15 PM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
On 11/9/22 at 3:50PM, Licensing Program Analyst (LPA) C. Lin conducted an unannounced case management visit as a result of receiving residents from Grand Lake Gardens (GLG) and check on residents. LPA met with Resident Health Services Director and explained the purpose of the visit.

A total of 15 residents from GLG are currently living in SPT including 2 in Assisted Living and 1 in Memory Care. There has no new admission from GLG since last visit. LPA met with 3 residents today who stated that they were feeling safe living at SPT and their needs were met. 1 resident concerned that she might move out after 3 months because SPT was not an affordable place for her. LPA will follow up with GLG.

Supplies are adequate and staffing is stable.

There was no imminent health/safety concerns on today's date.

Exit interview conducted with Resident Health Services Director and copy of this report provided.
SUPERVISOR'S NAME: Bennett FongTELEPHONE: (510) 622-2621
LICENSING EVALUATOR NAME: Catherine LinTELEPHONE: 510-622-2053
LICENSING EVALUATOR SIGNATURE:
DATE: 11/09/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/09/2022
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 1