<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 019200148
Report Date: 02/28/2025
Date Signed: 02/28/2025 06:22:43 PM

Document Has Been Signed on 02/28/2025 06:22 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:REMINGTON CARE HOME #2FACILITY NUMBER:
019200148
ADMINISTRATOR/
DIRECTOR:		BETH NUNEZFACILITY TYPE:
735
ADDRESS:27481 ORLANDO AVETELEPHONE:
(510) 785-9215
CITY:HAYWARDSTATE: CAZIP CODE:
94545
CAPACITY: 6CENSUS: 5DATE:
02/28/2025
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
04:00 PM
MET WITH:Ireneo Pascual and Angeline Cuevas, Staff,
and Jordan Deo Nunez, Assistant Administrator 		TIME VISIT/
INSPECTION COMPLETED:
06:30 PM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
On this day, 2/28/25, while at the facility for other reason, Licensing Program Analyst (LPA) Delmundo conducted a case management visit in response to the Special Incident Report (SIR) for resident (R1) and
SOC341 submitted by the facility and received by LPA on 2/03/25. LPA met with staff, Ireneo Pascual and Angeline Cuevas. LPA called and spoke over the phone with Beth Nunez, administrator (ADM), and informed the reason for visit. ADM stated she can not come to the facility, and authorized to have Ireneo Pascual to be with LPA during inspection and sign and receive this report. Jordan Deo Nunez, assistant administrator (AADM) arrived at around 4:15 pm.

SIR and SOC341 indicated that when AADM talked to staff (S1) due to work performance, S1 told AADM that staff (S2) hit resident (R1). AADM conducted an internal investigation.

LPA conducted interviews.

No deficiency cited during today's visit.

Exit interview conducted and copy of this report provided.
SUPERVISORS NAME: Bennett Fong
LICENSING EVALUATOR NAME: Alicia Delmundo
LICENSING EVALUATOR SIGNATURE: DATE: 02/28/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/28/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 1