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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 079200784
Report Date: 01/22/2025
Date Signed: 01/22/2025 01:19:57 PM

Document Has Been Signed on 01/22/2025 01:19 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
OAKLAND ASC, 1515 CLAY STREET, STE. 310
OAKLAND, CA 94612
FACILITY NAME:LAFAYETTE GARDENSFACILITY NUMBER:
079200784
ADMINISTRATOR/
DIRECTOR:		SAXENA, MEERANFACILITY TYPE:
740
ADDRESS:3486 MONROE AVENUETELEPHONE:
(408) 623-2859
CITY:LAFAYETTESTATE: CAZIP CODE:
94549
CAPACITY: 6TOTAL ENROLLED CHILDREN: 0CENSUS: 6DATE:
01/22/2025
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:40 AM
MET WITH:Administrator Meeran SaxenaTIME VISIT/
INSPECTION COMPLETED:
01:30 PM
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On 01/22/2025 at 10:40 AM, Licensing Program Analyst (LPA) David Doidge arrived to conduct 1-Year Annual Required inspection. LPA met with staff Aecia Perez. and explained the purpose of the visit.
The Administrator Meeran Saxena arrived at the facility at around 11:00 AM.

During the visit, LPA toured facility including but not limited to the kitchen, dining room, resident bedrooms and bathrooms, front and back area of the facility, and common areas. Fire extinguisher was observed full and purchased on 01/22/2025. Smoke detectors and carbon monoxide detectors were tested and observed functional. LPA observed the facility to be at a comfortable temperature for residents. All indoor and outdoor passageways are kept free of obstruction. Hot water temperature was measured at 107.7 degrees Fahrenheit. LPA observed skid mats and grab bars in resident bathrooms. LPA observed sufficient furniture and lighting throughout the facility. There are no bodies of water present in or around the facility. LPA observed a sufficient supply of 7 day non-perishables and two day perishable food supplies.

LPA reviewed six (6) resident files and four (4) staff files. All complete. Fire and earthquake drills are conducted quarterly. Last drills were conducted on 12/11/2024. Centrally stored medications were observed locked in a cabinet.

Continued on LIC809C.
Bennett FongTELEPHONE: (510) 286-4201
David DoidgeTELEPHONE: (916) 475-5913
DATE: 01/22/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/22/2025
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
OAKLAND ASC, 1515 CLAY STREET, STE. 310
OAKLAND, CA 94612
FACILITY NAME: LAFAYETTE GARDENS
FACILITY NUMBER: 079200784
VISIT DATE: 01/22/2025
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Continued from LIC809

The following forms to be updated and submitted to CCLD by 1/29/2025:
  • LIC500 (Personnel Record)
  • LIC308 (Designation of facility Responsibility)
  • Surety bond

No deficiencies were cited during this inspection.

Exit interview conducted and a copy of this report provided.
SUPERVISOR'S NAME: Bennett FongTELEPHONE: (510) 286-4201
LICENSING EVALUATOR NAME: David DoidgeTELEPHONE: (916) 475-5913
LICENSING EVALUATOR SIGNATURE:

DATE: 01/22/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/22/2025
LIC809 (FAS) - (06/04)
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