<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 011441151
Report Date: 05/03/2024
Date Signed: 05/03/2024 05:43:46 PM


Document Has Been Signed on 05/03/2024 05:43 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:ANGELEON CARE HOMEFACILITY NUMBER:
011441151
ADMINISTRATOR:DE LEON, RICHARDFACILITY TYPE:
740
ADDRESS:2124 ASHBY AVENUETELEPHONE:
(510) 704-8319
CITY:BERKELEYSTATE: CAZIP CODE:
94705
CAPACITY:12CENSUS: 10DATE:
05/03/2024
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
05:45 PM
MET WITH:Danilo "Sonny" Villar, Care StaffTIME COMPLETED:
06:00 PM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
On 05/03/24 around 05:45 PM, L. Holmes Licensing Program Analyst (LPA) arrived unannounced to conduct a 10-day complaint investigation. LPA was greeted by one (1) Care Staff. LPA explained the purpose of the visit to Danilo "Sonny" Villar, Care Staff. Richard De Leon, Administrator just left the facility.

During the visit, Danilo "Sonny" Villar, Care Staff cleared POC for staff training records.

Exit interview and a copy of this report provided to Danilo "Sonny" Villar, Care Staff.
SUPERVISOR'S NAME: Yvonne Flores-LariosTELEPHONE: (510) 286-0517
LICENSING EVALUATOR NAME: Lisha HolmesTELEPHONE: 510-286-4201
LICENSING EVALUATOR SIGNATURE:
DATE: 05/03/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/03/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 1