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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 019200250
Report Date: 02/20/2025
Date Signed: 02/20/2025 12:43:05 PM

Document Has Been Signed on 02/20/2025 12:43 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:MCCLURE CARE HOMEFACILITY NUMBER:
019200250
ADMINISTRATOR/
DIRECTOR:		MUNIZ, SHIELHA CFACILITY TYPE:
735
ADDRESS:2903 MCCLURE STREETTELEPHONE:
(510) 272-0104
CITY:OAKLANDSTATE: CAZIP CODE:
94609
CAPACITY: 25CENSUS: 22DATE:
02/20/2025
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:40 AM
MET WITH:Nelson Luat, CaregiverTIME VISIT/
INSPECTION COMPLETED:
01:15 PM
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On 02/20/2025 at 10:40 AM, Licensing Program Analyst (LPA) D. Doidge arrived unannounced to conduct an annual required inspection. LPA was met by staff Nelson Luat. LPA explained to Mr. Luat the purpose of the visit. Shielha Muniz was informed about the visit via phone call.

During the visits, LPA inspected the facility inside and out including but not limited to client rooms, bathrooms, dining, kitchen and other common areas. Water temperature in common bathroom measured at 111.3 degrees. There was sufficient supply of perishable and non perishable foods. Multiple fire extinguishers were observed that appeared full and were last serviced on 05/01/2025. Ample supply of hygiene products, towels, sheets and warm blankets were observed. Carbon monoxide were tested and observed functional. First aid kit was observed complete.

LPA reviewed five (5) staff and five (5) clients files. All were complete.

The last fire and earthquake drills were conducted on 12/20/2024 and are conducted quarterly. Centrally stored medications were observed locked in a cabinet.

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: 02/20/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/20/2025
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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