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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 019201200
Report Date: 10/27/2022
Date Signed: 10/27/2022 04:09:45 PM

Document Has Been Signed on 10/27/2022 04:09 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:OHANA HOME CAREFACILITY NUMBER:
019201200
ADMINISTRATOR:RIEZA, DEBBIEFACILITY TYPE:
735
ADDRESS:2424 ALMADEN BLVDTELEPHONE:
(925) 872-6836
CITY:UNION CITYSTATE: CAZIP CODE:
94587
CAPACITY: 4CENSUS: 4DATE:
10/27/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
03:00 PM
MET WITH:Debbie Rieza, Administrator/ ApplicantTIME COMPLETED:
04:23 PM
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On 10/27/2022 at 3:00PM, Licensing Program Analyst (LPA) G. Luk conducted a face to face Component III presentation. LPA met with Administrator/ Applicant, Debbie Rieza.

LPA presented Component III power point and discussed the regulations embodied in the presentation. LPA observed Administrator/ Applicant gained knowledge about running and maintaining the facility in accordance with Title 22 regulations.

LPA concluded Component III.

Exit interview conducted with Debbie Rieza and a copy of this report provided.

SUPERVISORS NAME: Harpreet Humpal
LICENSING EVALUATOR NAME: Grace Luk
LICENSING EVALUATOR SIGNATURE: DATE: 10/27/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/27/2022
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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