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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 019200922
Report Date: 08/19/2020
Date Signed: 08/19/2020 05:09:30 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:CASA SANDOVALFACILITY NUMBER:
019200922
ADMINISTRATOR:ROSANA FRIASFACILITY TYPE:
740
ADDRESS:1200 RUSSELL WAYTELEPHONE:
(510) 727-1700
CITY:HAYWARDSTATE: CAZIP CODE:
94541
CAPACITY:99CENSUS: 55DATE:
08/19/2020
TYPE OF VISIT:Case Management - OtherANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Executive Director Paul Gozon TIME COMPLETED:
11:10 AM
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Due to Shelter in Place Order and directive from management to telework, Licensing Program Analyst (LPA) Delmundo conducted an announced Component III Training via Teams Meeting. Component III was attended by the following: Senior VP of Operations Alexis Martini; Regional VP of Operations Melanie Seamans; Executive Director Paul Gozon; Associate Executive Director Rosana Frias; Wellness Director Bernadette Rosales; Assisted Living Coordinator Vivian Valeros

LPA presented the training in power point and had a discussion with the attendees.

A copy of this report provided to Mr. Gozon and Ms. Frias via e-mail on this same day, August 19, 2020.
SUPERVISOR'S NAME: Isaac TaggartTELEPHONE: (510) 363-5912
LICENSING EVALUATOR NAME: Alicia DelmundoTELEPHONE: (510) 286-4201
LICENSING EVALUATOR SIGNATURE:

DATE: 08/19/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/19/2020
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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