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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 019201449
Report Date: 03/21/2025
Date Signed: 03/21/2025 03:28:02 PM

Document Has Been Signed on 03/21/2025 03:28 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:BLEU MOON LIVINGFACILITY NUMBER:
019201449
ADMINISTRATOR/
DIRECTOR:		YAMBAO, JOAQUINFACILITY TYPE:
735
ADDRESS:35474 FARNHAM DRIVETELEPHONE:
(510) 709-0897
CITY:NEWARKSTATE: CAZIP CODE:
94560
CAPACITY: 4CENSUS: 0DATE:
03/21/2025
TYPE OF VISIT:PrelicensingANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
12:10 PM
MET WITH:Joaquin YambaoTIME VISIT/
INSPECTION COMPLETED:
02:30 PM
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On 03/21/2025 at 12:10 pm, Licensing Program Analyst Luisa Fontanilla arrived announced to conduct pre licensing inspection. LPA met with Joaquin Yambao and Licensee/Applicants. The facility has an approved fire clearance for 4 non ambulatory clients.

LPA toured facility with Licensees/Applicants inside and out including but not limited to 4 bedrooms which 2 bedrooms. Bedrooms and living rooms are equipped with the proper furniture. Bathrooms are equipped with grab bars and non-skid mats. There is supply of linens and hygiene supplies observed. There is sufficient lighting throughout facility. Room temperature was maintained at 68 degrees F and hot water temperature was maintained at 117 degrees Fahrenheit. First aid kit was observed to be complete. Smoke detectors and carbon monoxide were tested and observed operational. Fire extinguisher was last serviced on 3/16/2025.

The following deficiencies were observed:
  • no shade or covering for outdoor area use
  • no telephone unit
  • no activity supplies and materials
  • no internet service



The facility is not yet licensed. Pre licensing has not been completed until deficiencies are resolved by Tuesday, March 25, 2025.



Exit interview conducted and a copy of this report was provided to Licensees/applicants.
SUPERVISORS NAME: Yvonne Flores-Larios
LICENSING EVALUATOR NAME: Luisa Fontanilla
LICENSING EVALUATOR SIGNATURE: DATE: 03/21/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/21/2025
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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