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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 019201265
Report Date: 07/22/2024
Date Signed: 07/22/2024 05:36:31 PM

Document Has Been Signed on 07/22/2024 05:36 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:BETHANY HOMES SENIOR LIVING IIFACILITY NUMBER:
019201265
ADMINISTRATOR/
DIRECTOR:		PANIAGUA, RACHELLFACILITY TYPE:
740
ADDRESS:3356 EAST AVETELEPHONE:
(925) 640-6403
CITY:LIVERMORESTATE: CAZIP CODE:
94550
CAPACITY: 20CENSUS: 6DATE:
07/22/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
04:00 PM
MET WITH:Rachell Paniagua, AdministratorTIME VISIT/
INSPECTION COMPLETED:
05:00 PM
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On 7/22/2024 at 4:00PM, Licensing Program Analyst (LPA) G. Luk conducted a face to face Component III presentation. LPA met with Administrator, Rachell Paniagua.

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

LPA concluded Component III.

Exit interview conducted and a copy of this report provided.

SUPERVISORS NAME: Harpreet Humpal
LICENSING EVALUATOR NAME: Grace Luk
LICENSING EVALUATOR SIGNATURE: DATE: 07/22/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/22/2024
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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