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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 019201319
Report Date: 05/02/2024
Date Signed: 05/02/2024 02:36:46 PM


Document Has Been Signed on 05/02/2024 02:36 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
E BAY DELTA AC/SC, 1515 CLAY STREET, STE. 310
OAKLAND, CA 94612



FACILITY NAME:ANGELEON CARE HOMEFACILITY NUMBER:
019201319
ADMINISTRATOR:DE LEON, RICHARDFACILITY TYPE:
740
ADDRESS:2124 ASHBY AVENUETELEPHONE:
(650) 692-8945
CITY:BERKELEYSTATE: CAZIP CODE:
94705
CAPACITY:12CENSUS: 10DATE:
05/02/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
02:00 PM
MET WITH:Danilo Villar, CaregiverTIME COMPLETED:
03:00 PM
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On 05/02/2024 at 2:00 PM, Licensing Program Analysts (LPAs) Lori Alexander and Lisha Holmes attempted to conduct a face to face Component III presentation on 05/02/2024. LPAs met with Caregiver, Danilo "Sonny" Villar and explained the purpose of the visit. Sonny phoned the Licensee/Administrator, Richard De Leon to inform. LPAs spoke with Richard over the phone and Richard stated that he would not be available to come to the facility for the Component III presentation.

As a reminder, LPAs informed Richard De Leon, that per Title 22, Division 6, CCR 87405(a) All facilities shall...the licensee and the administrator may be one and the same person....shall be on the premises a sufficient number of hours to permit adequate attention to the management and administration of the facility as specified in this section.

Exit interview conducted and a copy of report provided
SUPERVISOR'S NAME: Bennett FongTELEPHONE: (510) 725-7919
LICENSING EVALUATOR NAME: Lori Alexander-WashingtonTELEPHONE: (510) 285-3934
LICENSING EVALUATOR SIGNATURE:
DATE: 05/02/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/02/2024
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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