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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 015202141
Report Date: 08/22/2024
Date Signed: 08/22/2024 02:35:20 PM

Document Has Been Signed on 08/22/2024 02:35 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:ELWYN NC - MONTECITOFACILITY NUMBER:
015202141
ADMINISTRATOR/
DIRECTOR:		DESIREE R. FREDELUCESFACILITY TYPE:
734
ADDRESS:36743 MONTECITO DRTELEPHONE:
(510) 494-9050
CITY:FREMONTSTATE: CAZIP CODE:
94536
CAPACITY: 5CENSUS: 5DATE:
08/22/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:50 PM
MET WITH:Desiree FredelucesTIME VISIT/
INSPECTION COMPLETED:
03:00 PM
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On this day at around 1:50 PM, LPAs Luisa Fontanilla and Patricia Manalo arrived unannounced to conduct a case management to follow up on the Department of Disability Services (DDS) regarding missing staff training. LPAs met with Administrator Desiree Fredeluces. LPAs explained to the Administrator the purpose of the visit.

During the visit, the Administrator provided LPAs proof of staff training on the training areas as required in CCR Sec 80065(f).

There are no deficiencies noted for this visit.

A copy of this report was provided to the Administrator.
SUPERVISORS NAME: Yvonne Flores-Larios
LICENSING EVALUATOR NAME: Luisa Fontanilla
LICENSING EVALUATOR SIGNATURE: DATE: 08/22/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/22/2024
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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