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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 015601479
Report Date: 10/13/2022
Date Signed: 10/14/2022 11:04:58 AM


Document Has Been Signed on 10/14/2022 11:04 AM - 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:HELPING HANDS HOME CAREFACILITY NUMBER:
015601479
ADMINISTRATOR:NASTAC, C.& CROITOR, L.FACILITY TYPE:
740
ADDRESS:4632 CROW CANYON PLACETELEPHONE:
(510) 728-4971
CITY:CASTRO VALLEYSTATE: CAZIP CODE:
94552
CAPACITY:6CENSUS: DATE:
10/13/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
02:30 PM
MET WITH:Irene Power, New Property Owner TIME COMPLETED:
02:55 PM
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On 10/13/22 Licensing Program Analyst (LPA) K. Nguyen conducted a Case Management visit to verify closure of the facility. Upon arrival at 2:30pm, LPA spoke with a housekeeper and was giving the owner contact information. LPA spoke with new property owner over the phone and confirmed that the facility been sold on Sept of last year 2021.
SUPERVISOR'S NAME: Bennett FongTELEPHONE: (510) 725-7919
LICENSING EVALUATOR NAME: Kelly NguyenTELEPHONE: (510) 915-8702
LICENSING EVALUATOR SIGNATURE:
DATE: 10/13/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/13/2022
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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