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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 019201129
Report Date: 11/19/2021
Date Signed: 11/19/2021 11:37:54 AM

Document Has Been Signed on 11/19/2021 11:37 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:CONNECTED LIVING OAKLANDFACILITY NUMBER:
019201129
ADMINISTRATOR:TRAIL, SARAFACILITY TYPE:
740
ADDRESS:1724 FILBERT STTELEPHONE:
(925) 826-6830
CITY:OAKLANDSTATE: CAZIP CODE:
94607
CAPACITY: 3CENSUS: 0DATE:
11/19/2021
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Sara Trail, AdministratorTIME COMPLETED:
10:45 AM
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On 11/19/2021 at 9:00 AM, Licensing Program Analyst (LPA) C. Lin arrived announced to conduct Pre-licensing Required inspection. LPA met with Administrator, Sara Trail and explained the purpose of the visit. The facility currently has no clients.

LPA toured facility including but not limited to 5 bedrooms, 4 bathrooms, 1 office, kitchen, common areas and backyard. Bedrooms and living rooms were equipped with the proper furniture. Bathrooms were equipped with non-skid mats. Linens and hygiene supplies were observed inside a cabinet. There is sufficient lighting throughout facility. Room temperature was maintained at 69 degrees F and hot water temperature was maintained at 110 degrees F. First-aid kits were observed to be complete. Smoke detectors and carbon monoxide were operational. Fire extinguisher was purchased on 08/01/2021. LPA observed the facility had the necessary posters in posted in common areas (i.e. Complaint poster, Personal Rights, Rights to Council, Visitation policy, Emergency Disaster Plan).

No deficiencies cited during the pre-licensing inspection. LPA observed the facility is ready to be licensed. However, this report will be submitted to the central application unit (CAU) and a final review of the application will be conducted. This facility is not yet licensed and is subject to final approval by CAU. Additional requirements may still be required.

Exit interview conducted and a copy of this report provided.
SUPERVISORS NAME: Bennett Fong
LICENSING EVALUATOR NAME: Catherine Lin
LICENSING EVALUATOR SIGNATURE: DATE: 11/19/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/19/2021
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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