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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 019200068
Report Date: 11/22/2024
Date Signed: 11/22/2024 11:29:34 AM

Document Has Been Signed on 11/22/2024 11:29 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 HOUSE ADULT EDUCATION PROGRAMFACILITY NUMBER:
019200068
ADMINISTRATOR/
DIRECTOR:		UNDERHILL, JAYNETTE NFACILITY TYPE:
775
ADDRESS:650 GRAND AVETELEPHONE:
(510) 208-4659
CITY:OAKLANDSTATE: CAZIP CODE:
94610
CAPACITY: 65CENSUS: 55DATE:
11/22/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:05 AM
MET WITH:Chandra Jackson, Adult Education ManagerTIME VISIT/
INSPECTION COMPLETED:
12:00 PM
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On 11/22/2024 at 10:00 AM, Licensing Program Analysts (LPAs) D. Doidge and A. Gharachorloo arrived unannounced to conduct 1-Year Annual Required inspection. LPAs met with, Chandra Jackson, Adult Education Manager and explained the purpose of the visit. Administrator Veronica Mercado Santana joined later.

LPAs toured the facility including but not limit to, bathrooms, and common area. Facility temperature was maintained at 68 degrees Fahrenheit. The hot water temperature in a common bathroom was measured at 107 degrees Fahrenheit.

Smoke detectors and carbon monoxide detectors were in operating condition during visit. Fire extinguisher was last serviced on 02/15/2024. Emergency disaster drills are conducted monthly, last conducted on 11/12/2024. First aid kit was observed to be complete.

LPAs reviewed five (5) resident records and four (4) staff records, all were complete.

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: 11/22/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/22/2024
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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