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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 011440834
Report Date: 03/24/2023
Date Signed: 03/24/2023 02:09:32 PM


Document Has Been Signed on 03/24/2023 02:09 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
CCLD Regional Office, 1515 CLAY STREET, STE. 310
OAKLAND, CA 94612



FACILITY NAME:ST. REGIS RETIREMENT CENTER, INC.FACILITY NUMBER:
011440834
ADMINISTRATOR:CHINIKAMWALA, SHABBIRFACILITY TYPE:
740
ADDRESS:23950 MISSION BLVD.TELEPHONE:
(510) 881-7888
CITY:HAYWARDSTATE: CAZIP CODE:
94544
CAPACITY:194CENSUS: 1DATE:
03/24/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH:Shabbir ChinakamwalaTIME COMPLETED:
02:15 PM
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On this day at approximately 1:00 pm, Licensing Program Analyst (LPA) Luisa Fontanilla, Licensing Program Manager (LPM) Yvonne Flores-Larios and Regional Manager (RM) Isaac Taggart arrived to conduct an announced visit and met with Administrator Shabbir Chinikamwala.

During the visit, LPA, LPM and RM visited the independent living, assisted living and Memory Care buildings.

There is no deficiency noted for this visit.

A copy of this report was provided to Administrator.
SUPERVISOR'S NAME: Yvonne Flores-LariosTELEPHONE: (510) 286-0517
LICENSING EVALUATOR NAME: Luisa FontanillaTELEPHONE: (510) 286-7147
LICENSING EVALUATOR SIGNATURE:
DATE: 03/24/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/24/2023
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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