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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 015601347
Report Date: 11/06/2024
Date Signed: 11/06/2024 12:00:30 PM

Document Has Been Signed on 11/06/2024 12:00 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
OAKLAND ASC, 1515 CLAY STREET, STE. 310
OAKLAND, CA 94612
FACILITY NAME:C & L HOME FOR THE ELDERLYFACILITY NUMBER:
015601347
ADMINISTRATOR/
DIRECTOR:		GUZMAN, JOSELITO A.FACILITY TYPE:
740
ADDRESS:2660 HOP RANCH ROADTELEPHONE:
(510) 731-7743
CITY:UNION CITYSTATE: CAZIP CODE:
94587
CAPACITY: 6TOTAL ENROLLED CHILDREN: 0CENSUS: 4DATE:
11/06/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:00 AM
MET WITH:Vincent Catequista, Care Staff TIME VISIT/
INSPECTION COMPLETED:
12:10 PM
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On 11/06/2024 at 8:00 AM, Licensing Program Analysts (LPAs) P. Manalo and K. Nguyen arrived unannounced to conduct 1-Year Annual Required inspection. LPAs met with Care Staff, Vincent Catequista and explained the purpose of the visit. Vincent phoned the Administrator (ADM) Joselito Guzman to inform the purpose of the visit and got verbal consent that staff can sign the report. The facility’s fire clearance was approved for six (6) all may be non-ambulatory and approved for two (2) hospice waiver .

Due to time, LPAs will return at another date to complete the annual inspection.

Exit interview conducted and a copy of this report provided.
Yvonne Flores-LariosTELEPHONE: (510) 286-4201
Patricia ManaloTELEPHONE: (916) 432-7785
DATE: 11/06/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/06/2024
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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