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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 03:27:21 PM

Document Has Been Signed on 03/21/2025 03:27 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:Case Management - OtherUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
02:30 PM
MET WITH:Joaquin YambaoTIME VISIT/
INSPECTION COMPLETED:
03:50 PM
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On this day at around 1:00 PM, LPA Luisa Fontanilla conducted Component lll with Licensees/Applicants Stefanie Ellis Gonzales, Raphael Yambao, Naneth Caderao and Administrator Joaquin Yambao.

LPA went over with Licensees/Applicants/Administrator Component lll Power point presentation. LPA provided applicant with CCL and LPA contact information.

A copy of this report was provided to 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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