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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 019201319
Report Date: 07/09/2024
Date Signed: 07/09/2024 04:26:41 PM


Document Has Been Signed on 07/09/2024 04:26 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:
07/09/2024
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
02:30 PM
MET WITH:Danilo "Sonny" Villar, CaregiverTIME COMPLETED:
04:40 PM
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On 07/09/2024 at 2:30 PM, Licensing Program Analysts (LPAs) L. Alexander and L. Holmes attempted to conduct a face to face Component III presentation. LPAs met with Caregiver, Danilo "Sonny" Villar and explained the purpose of the visit. LPA L. Alexander phoned the Licensee/Administrator, Richard De Leon to inform. LPAs spoke with Richard over the phone and Richard stated that he is currently on "the Peninsula" and would not be available to come to the facility for the Component III presentation.

On 05/02/2024 LPAs L. Alexander and L. Holmes made an unannounced visit to conduct Pre-Licensing inspection in which the new applicant, Mr. Richard De Leon, is administrator of the current license. LPAs L. Alexander and L. Holmes completed the physical plant segment of the Pre-Licensing inspection on 05/02/2024.

The Regional Office determined to waive the COMP III regulation due to the new applicant is also the current licensee and administrator.

No issues noted during inspection. LPA observed that facility is ready to be licensed. This report will be submitted to the Central Applications Unit (CAU) and a final review of the application will be conducted. This facility is not yet licensed, and is subject to final approval by CAU. Additional requirements may still be required.

Exit interview conducted and a copy of this report provided.
SUPERVISOR'S NAME: Bennett FongTELEPHONE: (510) 725-7919
LICENSING EVALUATOR NAME: Lori Alexander-WashingtonTELEPHONE: (510) 285-3934
LICENSING EVALUATOR SIGNATURE:
DATE: 07/09/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/09/2024
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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