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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 075600303
Report Date: 05/16/2023
Date Signed: 05/16/2023 03:29:10 PM


Document Has Been Signed on 05/16/2023 03:29 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
E BAY DELTA AC/SC, 1515 CLAY STREET, STE. 310
OAKLAND, CA 94612



FACILITY NAME:RAMONA CARE HOMEFACILITY NUMBER:
075600303
ADMINISTRATOR:VICTORIA LINGBANANFACILITY TYPE:
740
ADDRESS:2160 RAMONA DRIVETELEPHONE:
(925) 798-4930
CITY:PLEASANT HILLSTATE: CAZIP CODE:
94523
CAPACITY:6CENSUS: 5DATE:
05/16/2023
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
10:57 AM
MET WITH:Josefina Luy, CaregiverTIME COMPLETED:
03:45 PM
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On 5/16/2023 at 10:57 AM, Licensing Program Analyst (LPA) L. Alexander arrived unannounced to continue annual inspection from last visit on 05/11/2023. LPA met with caregiver, Josefina Luy. Johnny Lingbanan, husband to Licensee/Administrator, arrived shortly and advised that Victoria Lingbanan was currently taking a continuing education class.

LPA reviewed 5 of 5 resident's records.

Updated copies of the following documents were requested for facility file and are to be submitted to CCL by 05/23/2023:

LIC 308 Designation of Administrative Responsibility
LIC 309 Administrative Organization
LIC 500 Personnel Report
LIC 610E Emergency Disaster Plan
Liability Insurance
Current Administrator’s Certificate

No deficiencies cited during visit. Exit interview conducted and a copy of this report provided.
SUPERVISOR'S NAME: Bennett FongTELEPHONE: (510) 725-7919
LICENSING EVALUATOR NAME: Lori Alexander-WashingtonTELEPHONE: (510) 285-3934
LICENSING EVALUATOR SIGNATURE:
DATE: 05/16/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/16/2023
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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