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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 11:40:18 AM

Document Has Been Signed on 11/19/2021 11:40 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:Case Management - OtherANNOUNCEDTIME BEGAN:
10:45 AM
MET WITH:Sara Trail, AdministratorTIME COMPLETED:
12:00 PM
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On 11/19/2021 at 10:45 AM, Licensing Program Analyst (LPA) C. Lin conducted a Component III presentation with Administrator. LPA provided the Administrator sufficient information on how to operate the facility within substantial compliance as well as how to avoid common problem areas of facility operation.

Items discussed were clients refusing medications, AWOLs, engaging in inappropriate behaviors, money management, staffing, personnel records, clients' records, criminal record clearances, association to facility, centrally stored medications, locked toxic chemicals, Special incident reporting (LIC 624s), emergency/disaster plans/fire drills, in-service training for staff, first aid/CPR certifications, prohibited & restricted health conditions, universal precautions for staph infections, Personal rights, etc.

Administrator is appreciative of information shared during this presentation.
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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