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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 019201443
Report Date: 12/20/2024
Date Signed: 12/20/2024 10:54:28 AM

Document Has Been Signed on 12/20/2024 10:54 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:MALAMA HOME 2FACILITY NUMBER:
019201443
ADMINISTRATOR/
DIRECTOR:		RUIZ, THELMA B.FACILITY TYPE:
735
ADDRESS:35015 PECO STREETTELEPHONE:
(510) 475-8052
CITY:UNION CITYSTATE: CAZIP CODE:
94587
CAPACITY: 4CENSUS: 0DATE:
12/20/2024
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:00 AM
MET WITH:Thelma RuizTIME VISIT/
INSPECTION COMPLETED:
10:30 AM
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On 12/20/2024 at 9:00 AM, Licensing Program Analysts (LPAs) P. Manalo and L. Fontanilla announced to conduct pre licensing inspection. LPAs met with Licensee/Applicant, Thelma Ruiz and explained the purpose of the visit. The facility has an approved fire clearance for 4 ambulatory clients.

LPAs toured facility with Licensee/applicant including but not limited to 4 bedrooms which 3 bedrooms will be occupied for clients and one staff room, 1 office/receiving area, 2 bathrooms, kitchen, common areas and backyard. Bedrooms and living rooms were equipped with the proper furniture. Bathrooms were equipped with grab bars and non-skid mats. Linens and hygiene supplies were observed inside a cabinet. There is sufficient lighting throughout facility. Room temperature was maintained at 68 degrees F and hot water temperature was maintained at 108.2 degrees F. First-aid kit was observed to be complete. Smoke detectors and carbon monoxide were operational. Fire extinguisher was last serviced on 10/1/2024.

This facility is not yet licensed, and is subject to final approval by CAB. Additional requirements may still be required.

Exit interview conducted and a copy of this report was provided to Licensee/applicant.
SUPERVISORS NAME: Yvonne Flores-Larios
LICENSING EVALUATOR NAME: Luisa Fontanilla
LICENSING EVALUATOR SIGNATURE: DATE: 12/20/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/20/2024
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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