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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 019200088
Report Date: 05/21/2024
Date Signed: 05/21/2024 04:20:33 PM

Document Has Been Signed on 05/21/2024 04:20 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:CHAMBERS RESIDENTIAL CARE HOME #2, INC.FACILITY NUMBER:
019200088
ADMINISTRATOR/
DIRECTOR:		YVONNE CHAMBERSFACILITY TYPE:
735
ADDRESS:7825 OUTLOOK AVENUETELEPHONE:
(510) 568-5672
CITY:OAKLANDSTATE: CAZIP CODE:
94605
CAPACITY: 6CENSUS: 4DATE:
05/21/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
02:45 PM
MET WITH:Della BrewerTIME VISIT/
INSPECTION COMPLETED:
04:45 PM
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On 5/21/2024 at 2:45 pm , Licensing Program Analysts (LPAs) Greg Clark and A. Gharachorloo arrived unannounced to conduct 1-Year Annual Required inspection. LPAs met with Administrator, Bella Brewer and explained the purpose of the visit

LPAs 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. A comfortable temperature for clients is maintained at 74- degree Fahrenheit. LPAs observed lighting in all rooms are adequate for the comfort and safety of the clients. Hot water temperature in the shared clients’ bathroom was measured at 115.5-degree Fahrenheit. All toilets, hand washing, and bathing are safe, sanitary and in operating condition. The supply of extra hygiene was available for clients. There is a minimum of one-week supply of non-perishables and 2-day perishables food supply.

Smoke detectors and carbon monoxide were in operating condition during visit. Fire extinguisher was last serviced on 02/21/2024. Emergency Disaster Plan was last posted on 05/31/2021. First aid kit was observed to be complete. Fire drill was last conducted on 04/17/2024.

LPA reviewed 2 clients’ records and 2 staff records, and all were complete. A sample of 4 client’s medications were reviewed.


No deficiencies were cited during this inspection. Exit interview conducted and a copy of this report provided.
SUPERVISORS NAME: Yvonne Flores-Larios
LICENSING EVALUATOR NAME: Gregory Clark
LICENSING EVALUATOR SIGNATURE: DATE: 05/21/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/21/2024
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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