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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 10:55:28 AM

Document Has Been Signed on 12/20/2024 10:55 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:Case Management - OtherUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:30 AM
MET WITH:Thelma Ruiz/Charisma AguilarTIME VISIT/
INSPECTION COMPLETED:
11:10 AM
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On this day at around 10:30 am, LPAs L. Fontanilla and P. Manalo conducted Component lll with Licensee/applicant Thelma Ruiz and Charisma Ruiz.

LPAs went over with Licensee/ applicant Component lll Power point presentation. LPAs provided applicant with 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: 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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