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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 079201384
Report Date: 07/11/2024
Date Signed: 07/11/2024 01:52:00 PM


Document Has Been Signed on 07/11/2024 01:52 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:ECOLUX ASSISTED LIVINGFACILITY NUMBER:
079201384
ADMINISTRATOR:VERMA, BHARATFACILITY TYPE:
740
ADDRESS:158 MIRA VISTA DRTELEPHONE:
(650) 665-0894
CITY:OAKLEYSTATE: CAZIP CODE:
94561
CAPACITY:6CENSUS: 0DATE:
07/11/2024
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
11:00 AM
MET WITH:Bharat Verma, AdministratorTIME COMPLETED:
02:00 PM
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On 07/11/2024 at 11:00am, Licensing Program Analyst (LPA) T. Syess-Gibson conducted an announced pre-licensing inspection. LPA met with Bharat Verma, Licensee/Administrator, and explained the purpose of the visit. The facility has an approved fire safety clearance for six (6) non ambulatory residents.

LPA inspected the facility inside and out including but not limited to the bedrooms, bathrooms, common living areas, kitchen, garage, back yard. The facility has a six (6) bedrooms and three (3) bathrooms. There is sufficient lighting around the facility.

LPA observed two (2) out of the six (6) residents bedrooms are equipped with the proper furniture, bedding, and lighting. LPA observed Bathrooms showers/tubs were not equipped with installed grab bars. LPA did observe non skid mats in bathrooms shower/tubs. Passageways and hallways are free of obstruction. LPA observed no television in the common area. Administrator showed LPA proof of purchase with a delivery date of 07/18/2024.

LPA did not observed locked cabinets to store medications and sharps. Hot water temperature is measured at 112.1 degrees Fahrenheit in shared residents' bathroom. A comfortable temperature was observed at 77 degrees. Fire extinguisher was last purchased on 06/12/2024.

Continue LIC809C
SUPERVISOR'S NAME: Harpreet HumpalTELEPHONE: (510) 285-3928
LICENSING EVALUATOR NAME: Tonica Syess-GibsonTELEPHONE: (510) 414-0641
LICENSING EVALUATOR SIGNATURE:
DATE: 07/11/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/11/2024
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
OAKLAND ASC, 1515 CLAY STREET, STE. 310
OAKLAND, CA 94612
FACILITY NAME: ECOLUX ASSISTED LIVING
FACILITY NUMBER: 079201384
VISIT DATE: 07/11/2024
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continued from LIC809

LPA did not observe a minimum of 7-day non-perishables and 2-day perishables foods. First Aid kit was complete. Smoke detectors and carbon monoxide were in operating condition during visit.

Issues were noted during inspection. LPA observed that facility is not ready to be licensed.

Prior to licensure, the following shall be corrected by 07/18/2024


  • LPA observed not all bedrooms were equipped with the proper furniture, bedding, and lighting
  • LPA observed bathrooms showers didn't have Installed grab bars
  • LPA observed that there wasn't 7-day of non-perishables and 2-day of perishable foods
  • LPA observed there wasn't a locked cabinets to store medications and sharps
  • LPA observed no television in the common area


Exit interview conducted and a copy of this report provided
SUPERVISOR'S NAME: Harpreet HumpalTELEPHONE: (510) 285-3928
LICENSING EVALUATOR NAME: Tonica Syess-GibsonTELEPHONE: (510) 414-0641
LICENSING EVALUATOR SIGNATURE:

DATE: 07/11/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/11/2024
LIC809 (FAS) - (06/04)
Page: 2 of 2