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Department of
SOCIAL SERVICES
Community Care Licensing
FACILITY EVALUATION REPORT
Facility Number:
075600632
Report Date:
10/31/2023
Date Signed:
10/31/2023 05:02:53 PM
Document Has Been Signed on
10/31/2023 05:02 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:
TENDER TOUCH RESIDENTIAL CARE HOME
FACILITY NUMBER:
075600632
ADMINISTRATOR:
CRUZ, ESTRELLITA S.
FACILITY TYPE:
740
ADDRESS:
58 MIDHILL ROAD
TELEPHONE:
(925) 228-5683
CITY:
MARTINEZ
STATE:
CA
ZIP CODE:
94553
CAPACITY:
6
CENSUS:
5
DATE:
10/31/2023
TYPE OF VISIT:
Case Management - Other
UNANNOUNCED
TIME BEGAN:
04:30 PM
MET WITH:
Elyxandro Esteban, Caregiver
TIME COMPLETED:
05:00 PM
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On 10/31/2023 at 4:30 PM, LPA L. Alexander performed an Unannounced Case Management visit to deliver an amended 809 originally issued on 10/19/2023.
Exit interview conducted and a copy of this report provided.
SUPERVISOR'S NAME:
Bennett Fong
TELEPHONE:
(510) 725-7919
LICENSING EVALUATOR NAME:
Lori Alexander-Washington
TELEPHONE:
(510) 285-3934
LICENSING EVALUATOR SIGNATURE:
DATE:
10/25/2023
I acknowledge receipt of this form and understand my
licensing
appeal rights as
explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE:
10/25/2023
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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