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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 019200540
Report Date: 02/20/2025
Date Signed: 02/20/2025 10:01:23 AM

Document Has Been Signed on 02/20/2025 10:01 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:NOBLE HEARTS CARE HOMEFACILITY NUMBER:
019200540
ADMINISTRATOR/
DIRECTOR:		SHARONDALYN CONNERFACILITY TYPE:
735
ADDRESS:846 37TH STREETTELEPHONE:
(510) 250-9410
CITY:OAKLANDSTATE: CAZIP CODE:
94608
CAPACITY: 5CENSUS: 2DATE:
02/20/2025
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:00 AM
MET WITH:Administrator, Sharon ConnerTIME VISIT/
INSPECTION COMPLETED:
10:15 AM
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On 02/20/2025 at 09:00 AM, Licensing Program Analyst (LPA) D. Doidge arrived to conduct 1-Year Annual Required inspection. LPA met with Licensee/Administrator Sharon Conner, and explained the purpose of the visit.

During the visit, LPA toured facility including but not limited to the kitchen, dining room, resident bedrooms and bathrooms, front and back area of the facility, and common areas. Fire extinguisher was observed full, purchased on 10/28/2024. Smoke detectors and carbon monoxide detectors were tested and observed functional. LPA observed the facility to be at a comfortable temperature for residents. All indoor and outdoor passageways are kept free of obstruction. Hot water is set at 125 degrees Fahrenheit for cleaning purposes Hot water taps are marked with signs to prevent injury. LPA observed skid mats and grab bars in resident bathrooms. LPA observed sufficient furniture and lighting throughout the facility. There are no bodies of water present in or around the facility. LPA observed a sufficient supply of 7 day non-perishables and two day perishable food supplies.

LPA reviewed two (2) resident files and three (3) staff files. The last fire and earthquake drills were conducted on 02/01/2025 and are conducted monthly. 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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