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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 075600194
Report Date: 06/01/2020
Date Signed: 06/01/2020 03:26:24 PM

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:CHATEAU IIIFACILITY NUMBER:
075600194
ADMINISTRATOR:TRACEY INGLEMANFACILITY TYPE:
740
ADDRESS:175 CLEAVELAND ROADTELEPHONE:
(925) 935-1001
CITY:PLEASANT HILLSTATE: CAZIP CODE:
94523
CAPACITY:175CENSUS: 118DATE:
06/01/2020
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
02:00 PM
MET WITH:Tracey Ingleman, Executive DirectorTIME COMPLETED:
03:20 PM
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Licensing Program Analyst (LPA) Praveen Singh conducted a Case Management inspection with Executive Director Tracey Ingleman (ED) via video-conference due to the present shelter in place order by the Governor. Joining LPA during the inspection was Community Care Licensing Clinical Consultant Helen Shi.

Due to the number of Covid-19 positive residents and staff at the facility, LPA discussed additional information related to the facility's plan and the facility's policies and procedures regarding the protection of residents and staff. LPA made observations of isolation areas and the point of entry screening station. Also discussed during the inspection was information related to the Department's recent Hero Award Program.

Exit interview conducted and a copy of this report provided via email.
SUPERVISOR'S NAME: Julio MontesTELEPHONE: (510) 286-0518
LICENSING EVALUATOR NAME: Praveen SinghTELEPHONE: (510) 622-2625
LICENSING EVALUATOR SIGNATURE:

DATE: 06/01/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/01/2020
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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