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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 079201195
Report Date: 02/12/2025
Date Signed: 02/12/2025 10:44:43 AM

Document Has Been Signed on 02/12/2025 10:44 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
OAKLAND ASC, 1515 CLAY STREET, STE. 310
OAKLAND, CA 94612
FACILITY NAME:SCARLET HOUSE FOR THE ELDERLYFACILITY NUMBER:
079201195
ADMINISTRATOR/
DIRECTOR:		WHITE, RACHELFACILITY TYPE:
740
ADDRESS:5111 PAUL SCARLET DRIVETELEPHONE:
(650) 580-3239
CITY:CONCORDSTATE: CAZIP CODE:
94521
CAPACITY: 6CENSUS: 2DATE:
02/12/2025
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:20 AM
MET WITH:Carrene Coronel, CaregiverTIME VISIT/
INSPECTION COMPLETED:
11:00 AM
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On 2/12/2025 at 9:20 AM, Licensing Program Analyst (LPA) D. Doidge arrived to conduct an unannounced 1-Year Required inspection. LPA met with Carrene Coronel and Jose Coronel, Caregivers, and explained the purpose of the visit.

LPA toured the facility with Caregivers including but not limited to bedrooms, bathrooms, kitchen, common area, and back and side yard. The facility consists of six (6) bedrooms and three (3) bathrooms. A comfortable temperature of 72 degrees Fahrenheit is maintained. LPA observed lighting in all rooms are adequate for the comfort and safety of the residents. The hot water temperature in the residents’ shared bathroom was measured at 114 degrees Fahrenheit. Residents’ bathrooms are equipped with grab bars and non-skid mats.

Smoke detectors and carbon monoxide were in operating condition during visit. Fire extinguisher was last serviced on 01/22/2025. Emergency Disaster Plan was posted. First aid kit was observed to be complete.

LPA reviewed two (2) resident files and three (3) staff files, all were complete.

Continued on LIC809C.
SUPERVISORS NAME: Bennett Fong
LICENSING EVALUATOR NAME: David Doidge
LICENSING EVALUATOR SIGNATURE: DATE: 02/12/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/12/2025
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
OAKLAND ASC, 1515 CLAY STREET, STE. 310
OAKLAND, CA 94612
FACILITY NAME: SCARLET HOUSE FOR THE ELDERLY
FACILITY NUMBER: 079201195
VISIT DATE: 02/12/2025
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Continue from LIC 809

LPA requested the following documents to be submitted to CCLD by 2/19/2025.

· Resident Roster
· LIC 308 Designation of Administrative Responsibility
· LIC 309 Administrative Organization
· LIC 500 Personnel Report
· LIC 610E Emergency Disaster Plan (9 pages)
· Liability Insurance

No deficiencies observed or cited during this visit. .

Exit interview conducted and a copy of this report provided.
SUPERVISORS NAME: Bennett Fong
LICENSING EVALUATOR NAME: David Doidge
LICENSING EVALUATOR SIGNATURE:

DATE: 02/12/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/12/2025
LIC809 (FAS) - (06/04)
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