<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 415601129
Report Date: 05/31/2022
Date Signed: 05/31/2022 12:09:27 PM


Document Has Been Signed on 05/31/2022 12:09 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, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066



FACILITY NAME:JLA HEALTHCARE SERVICES LLCFACILITY NUMBER:
415601129
ADMINISTRATOR:LEONARD, JEROMEFACILITY TYPE:
740
ADDRESS:1185 ACACIA STREETTELEPHONE:
(510) 313-3673
CITY:MONTARASTATE: CAZIP CODE:
94037
CAPACITY:24CENSUS: 0DATE:
05/31/2022
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
10:30 AM
MET WITH:Administrators, Jerome Leonard and Eloisa BustamanteTIME COMPLETED:
12:20 PM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
On 5/31/2022, at 10:30am, Licensing Program Analyst (LPA) Murial Han conducted a follow-up pre-licensing inspection. LPA met with administrators, Jerome Leonard and Eloisa Bustamante and explained the purpose of today's visit.

Administrators provided a tour of the facility and LPA observed the entire facility to be cleaned and tidy. The resident's rooms are spacious and a few of them are equipped with furniture. The common areas- dinning room, hallway, and activity rooms appeared to be bright and the overall lighting and temperature are comfortable.

LPA observed bathrooms and showrooms are cleaned, and sanitary. The shower tubs have non-skid mats and grab bars.

The entire facility is hardwired with smoke detectors, fire sprinkler system, and fire panel. The fire panel was last inspected on 3/1/2022 and fire extinguishers were last inspected on 3/21/2022 and had passed all inspections conducted by Hue & Cry Inc. Carbon Monoxide detector is observed to be fully functional.

Comp III orientation was given to the Administrators, Jerome Leonard and Eloisa Bustamante

Pre-Licensing is now complete. Immediate Licensure is recommended pending final approval from the Central Applications Bureau.

Exit interview conducted with administrators.

A copy of the report is provided.
SUPERVISOR'S NAME: Julio MontesTELEPHONE: (650) 266-8811
LICENSING EVALUATOR NAME: Murial HanTELEPHONE: (619) 209-9761
LICENSING EVALUATOR SIGNATURE:
DATE: 05/31/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/31/2022
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 1