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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 011401135
Report Date: 02/02/2023
Date Signed: 02/02/2023 01:35:24 PM

Document Has Been Signed on 02/02/2023 01:35 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
CCLD Regional Office, 1515 CLAY STREET, STE. 310
OAKLAND, CA 94612
FACILITY NAME:CLAUSEN HOUSEFACILITY NUMBER:
011401135
ADMINISTRATOR:VERONICA MERCADO-SANTANAFACILITY TYPE:
735
ADDRESS:363 BELMONT STTELEPHONE:
(510) 839-0050
CITY:OAKLANDSTATE: CAZIP CODE:
94610
CAPACITY: 11CENSUS: 5DATE:
02/02/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
12:45 PM
MET WITH:Veronica Santana, AdministratorTIME COMPLETED:
01:45 PM
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On 2/02/23 at 12:45 p.m., Licensing Program Analyst (LPA) G. Clark arrived unannounced to deliver amended report for the allegation of unlawful eviction (see LIC9099 dated 2/02/23). LPA met with Administrator, Veronica Santana and explained the purpose of the visit.

Amended report delivered to administrator.

No deficiencies cited during visit. Exit interview conducted and a copy of this report provided.



SUPERVISORS NAME: Yvonne Flores-Larios
LICENSING EVALUATOR NAME: Gregory Clark
LICENSING EVALUATOR SIGNATURE: DATE: 01/30/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/30/2023
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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