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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 079200564
Report Date: 04/18/2024
Date Signed: 04/18/2024 01:53:30 PM

Document Has Been Signed on 04/18/2024 01:53 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:FRANCIS HOUSEFACILITY NUMBER:
079200564
ADMINISTRATOR/
DIRECTOR:		EDLOR SAPALARANFACILITY TYPE:
740
ADDRESS:2449 GILL PORT LANETELEPHONE:
(925) 939-7700
CITY:WALNUT CREEKSTATE: CAZIP CODE:
94598
CAPACITY: 6CENSUS: DATE:
04/18/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
12:45 PM
MET WITH:Administrator Edlor SapalaranTIME VISIT/
INSPECTION COMPLETED:
02:15 PM
NARRATIVE
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On 4/18/2024 at 12:45 PM, Licensing Program Analyst (LPA) J. Sampair arrived unannounced to conduct a case management inspection concerning the Fire Safety Inspection Request dated 6/30/2016 that includes the wording: "Door with bedridden resident and hall door to remain closed during sleeping hours".

The LPA called the Licensee Alberto Bernardino at 12:47 PM. As the LPA toured the facility, he and the Licensee spoke about the fire door in the hallway. It is a 2-hour fire door that the Fire Department had him install. It automatically closes when the smoke alarm is triggered by smoke. For that reason, the staff members are not required to shut the hallway door during sleeping hours.

No citations issued during inspection.

Exit interview conducted with and a copy of this report provided to Administrator Edlor Sapalaran.
SUPERVISORS NAME: Harpreet Humpal
LICENSING EVALUATOR NAME: James Sampair
LICENSING EVALUATOR SIGNATURE: DATE: 04/18/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/18/2024
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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