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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 019200346
Report Date: 12/26/2024
Date Signed: 12/26/2024 11:12:34 AM

Document Has Been Signed on 12/26/2024 11:12 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:CALLAHAN HOMEFACILITY NUMBER:
019200346
ADMINISTRATOR/
DIRECTOR:		GAIL CALLAHANFACILITY TYPE:
735
ADDRESS:658 VALLE VISTA AVENUETELEPHONE:
(510) 832-4258
CITY:OAKLANDSTATE: CAZIP CODE:
94610
CAPACITY: 12CENSUS: 8DATE:
12/26/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:00 AM
MET WITH:Amanda Callahan, AdministratorTIME VISIT/
INSPECTION COMPLETED:
11:30 AM
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On 12/26/2024 at 09:00 AM, Licensing Program Analysts (LPA) D. Doidge arrived unannounced to conduct 1-Year Annual Required inspection. LPA met with, Administrator Amanda Callahan and explained the purpose of the visit.

LPA toured the facility including but not limit to, bedrooms, bathrooms, multiple activity rooms, kitchen, common area and backyard. LPA observe lighting in all rooms are adequate for the comfort and safety of the residents. Hallway temperature was maintained at 70 degrees Fahrenheit. The hot water temperature in a common bathroom was measured at 113.6 degrees Fahrenheit. There is a minimum of one week supply of nonperishable and 2-day of perishable foods. Centrally stored medications, sharps 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 12/24/2024. Emergency disaster drill was last conducted on 11/13/2024, they are conducted monthly. First aid kit was observed to be complete.

LPA reviewed five (5) resident records and three (3) 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: 12/26/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/26/2024
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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