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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 019201143
Report Date: 08/22/2022
Date Signed: 08/22/2022 01:15:33 PM


Document Has Been Signed on 08/22/2022 01:15 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
CCLD Regional Office, 1515 CLAY STREET, STE. 310
OAKLAND, CA 94612



FACILITY NAME:ELEGANCE BERKELEYFACILITY NUMBER:
019201143
ADMINISTRATOR:BADOUD, ANDREWFACILITY TYPE:
740
ADDRESS:2100 SAN PABLO AVENUETELEPHONE:
(951) 310-0024
CITY:BERKELEYSTATE: CAZIP CODE:
94710
CAPACITY:120CENSUS: 0DATE:
08/22/2022
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Andrew Badoud, Executive DirectorTIME COMPLETED:
01:15 PM
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On 08/22/2022 at 10:00 AM, Licensing Program Analysts (LPAs) L. Holmes and Meenakshi Malik arrived announced to conduct a Pre-licensing Inspection. Upon arrival, LPAs were greeted by Andrew Badoud, Executive Director (ED). The facility is approved for a capacity of 120.

There was a screening station with a touchless thermometer, COVID-19 screening forms and signage, masks, and a dedicated receptionist desk with two staff. LPAs toured facility with ED, Nicole Dockson, Vice President of Operations-West (VP), and Angelica Gonzalez-Gillam, Director of Health and Wellness. LPAs toured facility including, but not limited to the common areas, activity/games rooms, bathrooms, salon, bistro, kitchen, sensory room, courtyards/patio, parking structure and offices. The rooms were equipped with the proper furniture and enough space for everyone to social distance. Lighting is sufficient throughout the facility. The Bathrooms were equipped with soap, covered garbage cans, and paper towels.Each resident has their own apartment or shared apartment. There was a sufficient supply of 7-day non-perishable foods. The room temperature was maintained at 70 degrees F and hot water temperature was maintained at 103 degrees F. First-aid kit was observed complete. Smoke detectors and carbon monoxide were operational and monitored by the Fire Department. Fire extinguisher was last serviced on 02/24/2022. August activity calendars were provided and Component III reviewed and completed with ED, VP and Director of Health and Wellness.
CORRECTIONS OBSERVED:
-Water temperature needs to be maintained between 105-120 degrees F.
-All staff needs to be associated to the facility prior to working at the facility.
LPAs observed that facility is not ready to be licensed. This report will be submitted to the Central Applications 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 to Andrew Badoud, Executive Director.
SUPERVISOR'S NAME: Yvonne Flores-LariosTELEPHONE: (510) 286-0517
LICENSING EVALUATOR NAME: Lisha HolmesTELEPHONE: 510-286-4201
LICENSING EVALUATOR SIGNATURE:
DATE: 08/22/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/22/2022
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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