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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 019201296
Report Date: 01/05/2024
Date Signed: 01/05/2024 10:49:50 AM

Document Has Been Signed on 01/05/2024 10:49 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:TINS ADULT DAY PROGRAMFACILITY NUMBER:
019201296
ADMINISTRATOR:ILAO, CRISTINAFACILITY TYPE:
775
ADDRESS:33131 ALVARADO NILES RDTELEPHONE:
(650) 580-5111
CITY:UNION CITYSTATE: CAZIP CODE:
94587
CAPACITY: 30CENSUS: 0DATE:
01/05/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Cristina IlaoTIME COMPLETED:
11:00 AM
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On this day at around 10am, Licensing Program Analyst (LPA) Luisa Fontanilla arrived announced to conduct Component lll and met with applicant Cristina Ilao.

LPA went over with applicant Component lll Powerpoint presentation. LPA provided applicant CCL and LPA contact information.

A copy of this report was provided to applicant.
SUPERVISORS NAME: Yvonne Flores-Larios
LICENSING EVALUATOR NAME: Luisa Fontanilla
LICENSING EVALUATOR SIGNATURE: DATE: 01/05/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/05/2024
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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