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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 019201129
Report Date: 11/18/2022
Date Signed: 11/18/2022 04:03:21 PM

Document Has Been Signed on 11/18/2022 04:03 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
E BAY DELTA AC/SC, 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: 1DATE:
11/18/2022
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
03:40 PM
MET WITH:Sara Trail, AdministratorTIME COMPLETED:
04:15 PM
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On 11/18/22 approximately at 3:40pm, Licensing Program Analyst (LPA) C. Lin arrived unannounced to conduct a proof of correction (POC) visit for the deficiencies cited on 11/3/2022. LPA met with Administrator and explained the purpose of the visit.

During visit, water temperature was observed at 112.4 degree F. Deficiency cleared. Civil penalty is discontinued at today's date.

No deficiencies are being cited on this date.

Exit interview conducted with Administrator and a copy of this report provided.
SUPERVISORS NAME: Bennett Fong
LICENSING EVALUATOR NAME: Catherine Lin
LICENSING EVALUATOR SIGNATURE: DATE: 11/18/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/18/2022
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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