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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 015601270
Report Date: 03/14/2025
Date Signed: 03/14/2025 06:56:47 PM

Document Has Been Signed on 03/14/2025 06:56 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:A GABRIELA'S VILLA-LIVERMOREFACILITY NUMBER:
015601270
ADMINISTRATOR/
DIRECTOR:
TRINIDAD, DUMITELA A.FACILITY TYPE:
740
ADDRESS:1051 LYNN STREETTELEPHONE:
(925) 998-4316
CITY:LIVERMORESTATE: CAZIP CODE:
94550
CAPACITY: 6TOTAL ENROLLED CHILDREN: 0CENSUS: 6DATE:
03/14/2025
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
06:00 PM
MET WITH:Bittum Narula, AdministratorTIME VISIT/
INSPECTION COMPLETED:
07:10 PM
NARRATIVE
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On 3/14/2025 at 6:00PM, Licensing Program Analyst (LPA) G. Luk arrived unannounced to conduct a case management inspection due to a change of ownership. LPA met with Administrator, Bittum Narula.


During Pre-licensing Inspection, LPA observed the following deficiency:

At 3:30PM, LPA observed broken lock in the garage cabinet, a hole in the living room ceiling, missing screen door, a hole in another screen door, a hole in the bathroom's window screen, a hole on the deck near living room, and items that need to be disposed in the backyard.


The deficiency was observed (see LIC 809D) and cited from the California Code of Regulation, Title 22. Failure to correct the deficiency may result in civil penalties.

Exit interview conducted. A copy of this report and appeal rights provided.
Harpreet HumpalTELEPHONE: (510) 285-3928
Grace LukTELEPHONE: (510) 286-4201
DATE: 03/14/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/14/2025
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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Document Has Been Signed on 03/14/2025 06:56 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1515 CLAY STREET, STE. 310
OAKLAND, CA 94612


FACILITY NAME: A GABRIELA'S VILLA-LIVERMORE

FACILITY NUMBER: 015601270

DEFICIENCY INFORMATION FOR THIS PAGE:

VISIT DATE: 03/14/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
04/01/2025
Section Cited
CCR
87303(a)

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Maintenance and Operation. The facility shall be clean, safe, sanitary and in good repair at all times... This requirement is not met as evidence by:
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Administrator has agreed to make the necessary repairs and dispose the items in the backyard. Administrator will submit picture proof to CCLD by POC date.
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Based on observation, licensee did not comply with the section cited above by having items that need to be repaired and dispose of which poses a potential health and safety risk to the persons in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
Harpreet HumpalTELEPHONE: (510) 285-3928
Grace LukTELEPHONE: (510) 286-4201

DATE: 03/14/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/14/2025

LIC809 (FAS) - (06/04)
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