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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 075601190
Report Date: 11/22/2024
Date Signed: 11/22/2024 10:23:55 AM

Document Has Been Signed on 11/22/2024 10:23 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
CCLD Regional Office, 1515 CLAY STREET, STE. 310
OAKLAND, CA 94612
FACILITY NAME:LT. COZY HOME CAREFACILITY NUMBER:
075601190
ADMINISTRATOR/
DIRECTOR:		TRIF, LETITIAFACILITY TYPE:
740
ADDRESS:3647 WREN AVENUETELEPHONE:
(925) 682-7582
CITY:CONCORDSTATE: CAZIP CODE:
94519
CAPACITY: 6TOTAL ENROLLED CHILDREN: 0CENSUS: 1DATE:
11/22/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:15 AM
MET WITH:Letitia Trif, LicenseeTIME VISIT/
INSPECTION COMPLETED:
10:30 AM
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On 11/22/24 at 9:15 am Licensing Program Analysts (LPA) J. Clancy-Czuleger arrived unannounced to do an annual inspection. LPA meet with Administrator Letitia Trif and explained the purpose of the visit.

LPA inspected the facility inside out. There is no body of water. Physical plant is consistent with the facility sketch received by Central Application Bureau (CAB) and approved by the fire department. LPA inspected the living room, dining area, kitchen, bedrooms, hallways, bathrooms, side and backyards. Bedrooms were observed appropriately furnished with adequate lighting and drawers.

At 9:30 am LPA reviewed 1 residents records. At 9:45 am, LPA reviewed 1 staff records and 1 of 1 were fingerprint cleared and associated to the facility.



No deficiencies cited during visit. Exit interview conducted and a copy of this report provided.
Harpreet HumpalTELEPHONE: (510) 285-3928
Jill Clancy-CzulegerTELEPHONE: 510-286-4201
DATE: 11/22/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/22/2024
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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