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

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 011400627
Report Date: 11/04/2024
Date Signed: 11/04/2024 10:56:45 AM

Document Has Been Signed on 11/04/2024 10:56 AM - 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:ST. PAUL'S TOWERSFACILITY NUMBER:
011400627
ADMINISTRATOR/
DIRECTOR:		YUEN, CONNIEFACILITY TYPE:
741
ADDRESS:100 BAY PLACETELEPHONE:
(510) 835-4700
CITY:OAKLANDSTATE: CAZIP CODE:
94610
CAPACITY: 320CENSUS: 208DATE:
11/04/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:40 AM
MET WITH:Cherry Marcelo, Healthcare AdministratorTIME VISIT/
INSPECTION COMPLETED:
11:10 AM
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 11/4/2024 at 9:40AM, Licensing Program Analyst (LPA) G. Luk arrived unannounced to amend report previously issued on 10/2/2024 and to assess civil penalty. LPA met with Healthcare Administrator, Cherry Marcelo and explained the purpose of the visit.


LPA amended report (LIC9099C and LIC9099D) previously issued on 10/2/2024. LPA printed the amended reports and provided a copy. Facility will look for the original reports and mail it back to LPA.

LPA assessed civil penalty of $500 for deficiency issued on 10/2/2024 regarding an individual who was not fingerprint cleared. LPA printed civil penalty and appeal rights and provided a copy.


Exit interview conducted. A copy of the reports was provided.
SUPERVISORS NAME: Harpreet Humpal
LICENSING EVALUATOR NAME: Grace Luk
LICENSING EVALUATOR SIGNATURE: DATE: 11/04/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/04/2024
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 1