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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 015600255
Report Date: 01/04/2024
Date Signed: 01/04/2024 01:24:20 PM


Document Has Been Signed on 01/04/2024 01:24 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:MERCY RETIREMENT & CARE CENTERFACILITY NUMBER:
015600255
ADMINISTRATOR:DAVIS, JOSEPHINE IFACILITY TYPE:
741
ADDRESS:3431 FOOTHILL BOULEVARDTELEPHONE:
(510) 534-8540
CITY:OAKLANDSTATE: CAZIP CODE:
94601
CAPACITY:160CENSUS: 87DATE:
01/04/2024
TYPE OF VISIT:Case Management - Health ChecksUNANNOUNCEDTIME BEGAN:
12:30 PM
MET WITH:Josephine Davis, AdminstratorTIME COMPLETED:
01:30 PM
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On 1/04/24 at 12:30 PM, Licensing Program Analyst (LPA) Greg Clark conducted a Health & Safety inspection as a result of notice received from Attorney General Bonta that he had approved a conditional change in the control and governance of this facility from Elder Care Alliance to Transforming Age. LPA met with Administrator, Josephine Davis and explained the purpose of the visit.

Due to the facility being in an active COVID out break status LPA was unable to tour the facility or speak to residents. LPA interviewed S1 during the visit.

S1 reported that on 12/15/23 a public meeting was held at the facility to discuss the change of control and governance of the facility. In attendance were: residents and family members, facility staff, the CEO's of both Elder Care Alliance and Transforming Age and the Assistant Attorney General of the State of California. The meeting lasted approximately 1.5 hours.

S1 further reported that there have been no changes at the facility. All staff and residents remain stable and there is no plans, at this point, to change any of the residents' contract to reflect the change of control and governance. The old contracts will remain in place.

No issues identified at this time.

No deficiencies cited during visit. Exit interview conducted and a copy of this report provided.
SUPERVISOR'S NAME: Yvonne Flores-LariosTELEPHONE: (510) 286-0517
LICENSING EVALUATOR NAME: Gregory ClarkTELEPHONE: 510-285-3927
LICENSING EVALUATOR SIGNATURE:
DATE: 01/04/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/04/2024
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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