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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 079201384
Report Date: 07/22/2024
Date Signed: 07/22/2024 12:42:00 PM


Document Has Been Signed on 07/22/2024 12:42 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:
07/22/2024
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
11:15 AM
MET WITH:Bharat Verma, AdministratorTIME COMPLETED:
12:00 PM
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On 07/22/2024 at 11:15AM, Licensing Program Analyst (LPA) T. Syess-Gibson conducted an announced pre-licensing inspection continuation from 07/11/2024. 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.

Component III conducted with Bharat Verma, Administrator on 07/22/2024.

Prior deficiencies noted on 07/11/2024 were corrected on 07/18/2024. LPA observed the facility is ready to be licensed. This report will be submitted to the central application 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

The applicant was reminded of the statute that requires CCLD to be notified within 5 business days of admitting their first resident. This notification may be done by phone, by mail, or by fax..

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: 07/22/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/22/2024
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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