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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 075600076
Report Date: 08/08/2024
Date Signed: 08/08/2024 01:42:01 PM


Document Has Been Signed on 08/08/2024 01:42 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
OAKLAND ASC, 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: DATE:
08/08/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
12:35 PM
MET WITH:Cathia Thia, CaregiverTIME COMPLETED:
01:45 PM
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On 08/08/2024 License Program Analysts (LPAs) Ardalan Gharachorloo and David Doidge arrived to conduct an annual required inspection. At 1:20 PM LPAs met with Administrator Tayyaba Chaudhry. Facility has a new name, Woodlands IV and licence number is 079201325. The Pre-licensing was done on 04//25/2024.
SUPERVISOR'S NAME: Yvonne Flores-LariosTELEPHONE: (510) 286-0517
LICENSING EVALUATOR NAME: Ardalan GharachorlooTELEPHONE: (510) 286-4201
LICENSING EVALUATOR SIGNATURE:
DATE: 08/08/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/08/2024
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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