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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 015601443
Report Date: 07/12/2024
Date Signed: 07/19/2024 03:03:32 PM


Document Has Been Signed on 07/19/2024 03:03 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:EAST BAY ASSISTED LIVINGFACILITY NUMBER:
015601443
ADMINISTRATOR:KUANG, ALICE & MICHAELFACILITY TYPE:
740
ADDRESS:1301 EAST 31ST STREETTELEPHONE:
(510) 532-5986
CITY:OAKLANDSTATE: CAZIP CODE:
94602
CAPACITY:68CENSUS: 38DATE:
07/12/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
12:17 PM
MET WITH:Chun Hang NgTIME COMPLETED:
03:05 PM
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On 07/12/2024 at 12:17 PM, Licensing Program Analyst (LPA) Ardalan Gharachorloo arrived unannounced to conduct 1-Year Annual Required inspection. LPA met with Administrator , Chun Hang and explained the purpose of the visit.

LPA toured the facility including but not limited to 4 residents’ rooms, bathrooms, activity rooms, kitchen, common area and courtyard. LPA observe lighting in all rooms are adequate for the comfort and safety of the residents. Hallway temperature was maintained at 76 degrees F. The hot water temperature in a residents’ shared bathroom was measured at 117.6 degrees Fahrenheit. Residents’ bathrooms are equipped with grab bars and non-skid mats. There is a minimum of one week supply of nonperishable and 2-day of perishable foods. Centrally stored medications, sharps and toxic 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 10/24/2023. Emergency Disaster Plan was last posted on 03/14/2019. First aid kit was observed to be complete. Emergency disaster drill was last conducted on 06/18/2024.


LPA reviewed 5 residents records and 5 staff records, and all were complete. At 1:35 PM, LPA also reviewed a sample of resident’s medications. A copy of the liability insurance was reviewed and is up to date.

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: Ardalan GharachorlooTELEPHONE: (510) 286-4201
LICENSING EVALUATOR SIGNATURE:
DATE: 07/12/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/12/2024
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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