Facility Evaluation Report

Jackson House IV, San Leandro12/31/2024Licence 015600532

Capacity6
Census4
Date signed12/31/2024 04:43:31 PM
The inspector’s account

On 12/31/2024 at approximately 8:00 AM, Licensing Program Analyst (LPA) James Sampair arrived unannounced to conduct the Required Annual Inspection of the facility. Upon arrival, LPA stated the purpose of the visit to Caregiver Lydia Alvarez. Administrator Wardell Jackson arrived at approximately 9:30 AM.

The LPA 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 73.3 degrees Fahrenheit and the hot water temperature was 119.4 degrees Fahrenheit. The LPA observed adequate lighting in all of the rooms for the comfort and safety of the individuals. The LPA observed more than the minimum of 7 days of nonperishable food. There was no edible perishable food until the Administrator arrived and opened the locked storage building in the backyard. Sharps and other dangerous items were stored inaccessibly to residents. Smoke and carbon monoxide detectors were in operating condition. Fire extinguishers observed to be fully charged and last serviced on 12/4/2024.

The LPA reviewed the records of 4 consumers and 5 staff members.

6 B-Type citations issued (refer to LIC 809-D for details).

Exit interview conducted and a copy of this report provided.

Source: California Department of Social Services, Community Care Licensing. Methodology · Report a correction