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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 019201345
Report Date: 05/23/2024
Date Signed: 05/23/2024 02:55:00 PM

Document Has Been Signed on 05/23/2024 02:55 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:RIVER OAK RESIDENTIAL CARE HOMEFACILITY NUMBER:
019201345
ADMINISTRATOR/
DIRECTOR:		RIVERA-VALLESTERO, JAMIEFACILITY TYPE:
735
ADDRESS:2088 TRAFALGAR AVETELEPHONE:
(510) 676-4569
CITY:HAYWARDSTATE: CAZIP CODE:
94545
CAPACITY: 6CENSUS: 0DATE:
05/23/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:55 PM
MET WITH:Jamie Rivera-Vallestero/Applicant-Administrator and
Corporate Officer/Applicant Janice Lapuz		TIME VISIT/
INSPECTION COMPLETED:
03:00 PM
NARRATIVE
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Licensing Program Analyst (LPA) Delmundo conducted an announced Component III Training via Teams Meeting. Component III was attended by Jamie Rivera-Vallestero, applicant-administrator and
Corporate Officer, applicant Janice Lapuz

LPA presented the training via Power Point presentation, and had a discussion with the applicants.

Exit interview conducted, and copy of this report provided at the conclusion of the training.
SUPERVISORS NAME: Bennett Fong
LICENSING EVALUATOR NAME: Alicia Delmundo
LICENSING EVALUATOR SIGNATURE: DATE: 05/23/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/23/2024
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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