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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 079201260
Report Date: 05/04/2023
Date Signed: 05/04/2023 01:51:35 PM

Document Has Been Signed on 05/04/2023 01:51 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:ACQUIRED LIVING LLCFACILITY NUMBER:
079201260
ADMINISTRATOR:BOATNER, SALINAFACILITY TYPE:
735
ADDRESS:2194 MEGAN DRIVETELEPHONE:
(925) 206-1947
CITY:OAKLEYSTATE: CAZIP CODE:
94531
CAPACITY: 4CENSUS: 0DATE:
05/04/2023
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
09:15 AM
MET WITH:BOATNER, SALINA, Applicant TIME COMPLETED:
12:05 PM
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ON 5/4/2023 at around 9:15AM, Licensing Program Analyst (LPA) L. Ibo conducted an announced pre-licensing inspection. License application is for four (4) total capacity, all ambulatory. LPA was met by applicant Salian Boatner.

LPA toured the facility inside out with Salina Boatner. There is a body of water at the facility’s backyard. Physical plant is consistent with the facility sketch received by Central Application Bureau (CAB) and approved by the fire department. LPA inspected the living room, dining area, family room, kitchen, bedrooms. Bedrooms were observed appropriately furnished with adequate lighting and drawers. Facility has sufficient towels, extra bed sheets and comforters. Equipment and supplies for clients' personal hygiene are available and on site. Dinner and silver wares were observed sufficient for clients' use. Food supplies checked and observed sufficient good for seven days of non-perishables, LPA advised applicant that once she admitted the first client the facility needs 2 days of perishables. Facility was observed equipped with refrigerator, microwave, dishwasher, washer, and dryer. Bathroom/shower was observed equipped with grab bars and non-skid mat.

A new fire extinguisher was observed fully charge. The two-in-one carbon monoxide and smoke detector was tested and observed operational. First aid kit inspected and observed complete with manual. Facility has flashlight for emergency lighting. Hot water temperature in the bathrooms was tested. Ombudsman and complaint posters, Right to Resident Council, Right to Family Council, Theft and Loss Program/Policy and Residents Personal Rights were observed posted in the prominent place.

...Continue to LIC809C...
SUPERVISORS NAME: Harpreet Humpal
LICENSING EVALUATOR NAME: Leslie Ibo
LICENSING EVALUATOR SIGNATURE: DATE: 05/04/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/04/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 2
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1515 CLAY STREET, STE. 310
OAKLAND, CA 94612
FACILITY NAME: ACQUIRED LIVING LLC
FACILITY NUMBER: 079201260
VISIT DATE: 05/04/2023
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The following were discussed and requested to be updated and/or corrected.

1. Facility needs a secure fence for the body of water (pond/fountain) located at the facility’s backyard

COMPONENT III was discussed with applicant.

A re-inspection is needed to follow up the secure fence for the body of water.
License is pending final review by CAB analyst.

Copy of this report provided to Salina Boatner. Exit interview conducted and a copy of this report provided.
SUPERVISORS NAME: Harpreet Humpal
LICENSING EVALUATOR NAME: Leslie Ibo
LICENSING EVALUATOR SIGNATURE:

DATE: 05/04/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/04/2023
LIC809 (FAS) - (06/04)
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