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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 019200956
Report Date: 12/11/2024
Date Signed: 12/11/2024 12:58:47 PM

Document Has Been Signed on 12/11/2024 12:58 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:ELDER ASHRAMFACILITY NUMBER:
019200956
ADMINISTRATOR/
DIRECTOR:		MEESHIA MARY T SANTOSFACILITY TYPE:
740
ADDRESS:3121 FRUITVALE AVETELEPHONE:
(510) 842-3192
CITY:OAKLANDSTATE: CAZIP CODE:
94602
CAPACITY: 90CENSUS: 62DATE:
12/11/2024
TYPE OF VISIT:Case Management - Health ChecksUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:20 AM
MET WITH:Janelle Ubilas Interim AdministratorTIME VISIT/
INSPECTION COMPLETED:
01:15 PM
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On 12/11/2024 at 10:20 AM, Licensing Program Analysts (LPAs), D. Doidge and L. Fontanilla conducted an unannounced health and safety check related to complaint 15-AS-20241206141605. LPAs met with Interim Administrator Janelle Ubilas and explained the nature of the visit.

The LPAs inspected the facility inside and outside. All outdoor and indoor passageways were free of obstruction. Outside, there were no bodies of water. Inside, the temperature was measured at 73 degrees Fahrenheit. The LPAs observed adequate lighting in all of the rooms for the comfort and safety of the residents. The hot water temperature in a common bathroom was measured at 114.7 degrees Fahrenheit. Kitchen was observed to be clean with food for 2 days of perishables and 7 days of non-perishables. Central storage for medications and cleaning supplies were observed locked. Sharps were stored inaccessible to residents. Fire extinguisher was observed to be fully charged and last serviced on 02/16/2024.

No citations issued.

A copy of this report was provided to Janelle Ubilas, Interim Administrator.
SUPERVISORS NAME: Bennett Fong
LICENSING EVALUATOR NAME: David Doidge
LICENSING EVALUATOR SIGNATURE: DATE: 12/11/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/11/2024
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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