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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 011440289
Report Date: 05/19/2020
Date Signed: 06/11/2020 04:12:46 PM

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:DIANA'S CARE HOMEFACILITY NUMBER:
011440289
ADMINISTRATOR:OLIVE MANALASTASFACILITY TYPE:
740
ADDRESS:27402 MANON AVETELEPHONE:
(510) 786-9982
CITY:HAYWARDSTATE: CAZIP CODE:
94544
CAPACITY:32CENSUS: 6DATE:
05/19/2020
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Olive Manalastas, AdministratorTIME COMPLETED:
10:00 AM
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On 05/19/20 at 9:30 AM, LPA D Panlilio conducted an unannounced tele-visit with Administrator to discuss amended 9099s per complaint 15-AS-20200121100031. Amended 9099s generated and mailed to facility on this date supersedes the original report generated and provided to facility on 1/23/2020. LPA requested and facility agreed to return the signed original 9099s.

Due to the current COVID-19 shelter in place issued by the Governor on March 17, 2020, a facility visit was not possible and the Administrator was not physically able to sign.

No deficiencies cited during this tele-visit.

Exit interview conducted via televist and a copy of the Amended 9099s were sent to Administrator on this date.
SUPERVISOR'S NAME: Rajind BasiTELEPHONE: (510) 286-4201
LICENSING EVALUATOR NAME: Daisy PanlilioTELEPHONE: (510) 286-4201
LICENSING EVALUATOR SIGNATURE:

DATE: 06/10/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/10/2020
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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