<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 075600076
Report Date: 12/20/2022
Date Signed: 12/20/2022 10:14:24 AM


Document Has Been Signed on 12/20/2022 10:14 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
E BAY DELTA AC/SC, 1515 CLAY STREET, STE. 310
OAKLAND, CA 94612



FACILITY NAME:HAPPY VALLEY-HOME FOR OUR PARENTSFACILITY NUMBER:
075600076
ADMINISTRATOR:ONOFREI, NICOLAEFACILITY TYPE:
740
ADDRESS:3292 WALNUT LANETELEPHONE:
(925) 284-4846
CITY:LAFAYETTESTATE: CAZIP CODE:
94549
CAPACITY:6CENSUS: 0DATE:
12/20/2022
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
09:20 AM
MET WITH:Damaris Onofrei, AdministratorTIME COMPLETED:
10:20 AM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
On 12/20/22 approximately 9:20am, Licensing Program Analyst (LPA) C. Lin arrived unannounced to conduct a proof of correction (POC) visit for the deficiencies cited on 12/6/22. LPA met with Administrator and explained the purpose of the visit.

87465(a)(5)(A) and 87224(a)(5)(A)
Administrator stated that she had submitted POC to CCLD in a timely manner. Administrator resubmitted both POCs to LPA on today's visit. Deficiencies Cleared.

No Deficiency and Civil Penalty are being assessed on this date..

LPA observed that no resident is living in the facility currently. Administrator stated that licensee would sell the property. Administrator understand that licensee couldn't sell the license/business, when licensee is out of control of the property, facility license is ceased..

Exit interview conducted and a copy of this report provided.
SUPERVISOR'S NAME: Bennett FongTELEPHONE: (510) 622-2621
LICENSING EVALUATOR NAME: Catherine LinTELEPHONE: 510-622-2053
LICENSING EVALUATOR SIGNATURE:
DATE: 12/20/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/20/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 1