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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 019200656
Report Date: 11/14/2024
Date Signed: 11/14/2024 11:42:09 AM

Document Has Been Signed on 11/14/2024 11:42 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
CCLD Regional Office, 1515 CLAY STREET, STE. 310
OAKLAND, CA 94612
FACILITY NAME:JAY MAHLER RECOVERY CENTERFACILITY NUMBER:
019200656
ADMINISTRATOR/
DIRECTOR:		GARCIA, DENISE GFACILITY TYPE:
772
ADDRESS:15430 FOOTHILL BOULEVARDTELEPHONE:
(510) 357-3562
CITY:SAN LEANDROSTATE: CAZIP CODE:
94578
CAPACITY: 16CENSUS: 10DATE:
11/14/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:55 AM
MET WITH:Adaminah Victoria, AdministratorTIME VISIT/
INSPECTION COMPLETED:
11:40 AM
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Licensing Program Analyst (LPA) J. Clancy-Czuleger arrived unannounced to conduct an annual required inspection. LPA met with Administrator Adaminah Victoria and explained the purpose of the visit. LPA verified all staff present received their criminal record clearances and were associated to the facility.

This is a short-term residential Social Rehabilitation Facility. LPA toured facility inside and out. LPA observed a quiet room, library, and kitchen/dining room for the residents' use. LPA toured the kitchen and observed a sufficient two (2) day supply of perishable and seven (7) day supply of non-perishable foods. LPA observed disinfectants and cleaning supplies were kept locked. LPA observed that all outside passageways and exits were free of obstructions. LPA observed auditory signals leading to outside areas were in working order. LPA observed that all centrally stored medications were locked and centrally stored medications were properly labeled and physician orders were maintained in the file. LPA observed that a comfortable temperature was maintained throughout the facility. LPA observed first aid kits were maintained and that the fire extinguishers were last serviced on 10/01/2024. Water temperature measured at 106.1. A sampling of staff and resident files were reviewed. Facility staff have sufficient training to meet resident needs and are First Aid and CPR certified. Residents have updated needs and services plans.

LPA observed the facility is in substantial compliance. No deficiencies are being cited during this inspection. Exit interview conducted and a copy of this report provided.
SUPERVISORS NAME: Harpreet Humpal
LICENSING EVALUATOR NAME: Jill Clancy-Czuleger
LICENSING EVALUATOR SIGNATURE: DATE: 11/14/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/14/2024
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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