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

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 011401135
Report Date: 11/19/2024
Date Signed: 11/19/2024 11:34:39 AM

Document Has Been Signed on 11/19/2024 11:34 AM - 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:CLAUSEN HOUSEFACILITY NUMBER:
011401135
ADMINISTRATOR/
DIRECTOR:		VERONICA MERCADO-SANTANAFACILITY TYPE:
735
ADDRESS:363 BELMONT STTELEPHONE:
(510) 839-0050
CITY:OAKLANDSTATE: CAZIP CODE:
94610
CAPACITY: 11CENSUS: 3DATE:
11/19/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:00 AM
MET WITH:Administrator Veronica Mercado SantanaTIME VISIT/
INSPECTION COMPLETED:
12:00 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 11/19/2024 at 10:00 AM, Licensing Program Analysts (LPAs) D. Doidge and K. Nguyen arrived unannounced to conduct 1-Year Annual Required inspection. LPAs met with, Administrator Veronica Mercado Santana and explained the purpose of the visit.

Current facility is under renovations. Due to an emergency at Administrator's other facility, staff and residents are being temporarily housed at this facility.

LPAs toured the facility including but not limit to, bedrooms, bathrooms, multiple activity rooms, kitchen, common area and backyard. LPAs observe lighting in all rooms are adequate for the comfort and safety of the residents. Hallway temperature was maintained at 70 degrees Fahrenheit. The hot water temperature in a common bathroom was measured at 109.1 degrees Fahrenheit. There is a minimum of one week supply of nonperishable and 2-day of perishable foods. Centrally stored medications, sharps are locked and inaccessible to residents in care.

Smoke detectors and carbon monoxide detectors were in operating condition during visit. Fire extinguisher was last serviced on 02/13/2024. Emergency disaster drill was last conducted on 08/07/2024. First aid kit was observed to be complete.

LPAs reviewed resident records and staff records at on 10/23/2024 from another other facility..

No deficiencies observed or cited during this visit. .

Exit interview conducted and a copy of this report provided.
SUPERVISORS NAME: Bennett Fong
LICENSING EVALUATOR NAME: David Doidge
LICENSING EVALUATOR SIGNATURE: DATE: 11/19/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/19/2024
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