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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 015601363
Report Date: 02/12/2021
Date Signed: 02/12/2021 06:16:54 PM

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 & P CARE HOME FOR SENIORSFACILITY NUMBER:
015601363
ADMINISTRATOR:DUMITELA DIMAPILISFACILITY TYPE:
740
ADDRESS:32852 CLEAR LAKE STREETTELEPHONE:
(510) 487-8758
CITY:FREMONTSTATE: CAZIP CODE:
94555
CAPACITY:6CENSUS: 6DATE:
02/12/2021
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
06:10 PM
MET WITH:Dumitela "Ella" Dimapilis, AdministratorTIME COMPLETED:
06:20 PM
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On 2/12/2021, Licensing Program Analyst (LPA) L. Francisco conducted a Case Management phone call to deliver amended report from 2/3/2021 via Facetime due to shelter in place directed by the Governor. LPA spoke with Administrator, Dumitela "Ella" Dimapilis.

Exit interview conducted and a copy of amended report provided via email.
SUPERVISOR'S NAME: Harpreet HumpalTELEPHONE: (510) 285-3928
LICENSING EVALUATOR NAME: Lizette FranciscoTELEPHONE: (510) 286-4201
LICENSING EVALUATOR SIGNATURE:

DATE: 02/03/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/03/2021
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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