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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 019201143
Report Date: 05/25/2023
Date Signed: 05/25/2023 04:39:38 PM


Document Has Been Signed on 05/25/2023 04:39 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: 48DATE:
05/25/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
04:00 PM
MET WITH:Andrew Badoud, Executive DirectorTIME COMPLETED:
05:00 PM
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On 05/25/23 around 04:00 PM, Licensing Program Analyst (LPA) L. Holmes arrived unannounced and conducted a post licensing visit. LPA met with Andrew Badoud, Executive Director (ED) and Claudia Lopes, Director of Business Administration and explained the purpose of the visit.

The staff members interviewed were fingerprint cleared and associated to this facility. There was sufficient lighting throughout the facility. The facility offers assisted living and memory care. There were no bodies of water present in or around the facility. Bathrooms were equipped with the required hygiene items. Common areas are equipped with adequate furniture for the residents. The salon is in service and a pianist was performing for staff and residents. Fire extinguishers were present throughout the facility, observed full, and ADM to add new tag to portable fire extinguishers. Smoke detectors and carbon monoxide detectors were located throughout the facility and operational. There is a Med. Tech./Nurses Station on site with first aid equipment present. Emergency Disaster Plan is on file and the facility was maintained at a comfortable temperature.

No deficiencies cited during this post-licensing inspection.

Exit interview conducted and a copy of this report was provided 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: 05/25/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/25/2023
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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