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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 015601242
Report Date: 02/21/2025
Date Signed: 03/07/2025 03:05:58 PM

Document Has Been Signed on 03/07/2025 03:05 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
OAKLAND ASC, 1515 CLAY STREET, STE. 310
OAKLAND, CA 94612
FACILITY NAME:HEART & SOUL COMMUNITIESFACILITY NUMBER:
015601242
ADMINISTRATOR/
DIRECTOR:		TILLIS, ERICKAFACILITY TYPE:
740
ADDRESS:3770 SUTER STREETTELEPHONE:
(510) 927-8046
CITY:OAKLANDSTATE: CAZIP CODE:
94619
CAPACITY: 6CENSUS: 0DATE:
02/21/2025
TYPE OF VISIT:Required - 1 YearANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
02:00 PM
MET WITH:Ericka Tillis, AdministratorTIME VISIT/
INSPECTION COMPLETED:
03:15 PM
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On 03/07/2025 at 2:00 PM, Licensing Program Analyst (LPA) Ardalan Gharachorloo arrived to conduct 1-Year Annual Required inspection. LPA met with Administrator,Ericka Tillis and explained the purpose of the visit. Administrator stated there are no residents in care.


LPA observed that there are currently no residents in care and there are no staff working at the facility.

At 2:20 PM, LPA toured the facility including but not limited to bedrooms, bathrooms, kitchen, common area and backyard. All outdoor and indoor passageways are kept free of obstruction. There are no bodies of water observed. The hot water temperature in the bathrooms were measured at 112 degrees Fahrenheit. Bathrooms are equipped with grab bars and non-skid mats.

Smoke detectors and carbon monoxide detectors were in operating condition during visit. Fire extinguisher was last serviced on 03/07/2025. LPA also checked the emergency exit.


Exit interview conducted AT 2:55 PM and a copy of this report provided.
SUPERVISORS NAME: Yvonne Flores-Larios
LICENSING EVALUATOR NAME: Ardalan Gharachorloo
LICENSING EVALUATOR SIGNATURE: DATE: 02/21/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/21/2025
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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