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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 075601216
Report Date: 06/20/2024
Date Signed: 06/20/2024 11:20:47 AM


Document Has Been Signed on 06/20/2024 11:20 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:ABEL CARE HOMEFACILITY NUMBER:
075601216
ADMINISTRATOR:MATIAS, JERRYFACILITY TYPE:
740
ADDRESS:899 PLA VADA COURTTELEPHONE:
(925) 798-0550
CITY:CONCORDSTATE: CAZIP CODE:
94518
CAPACITY:6CENSUS: 6DATE:
06/20/2024
TYPE OF VISIT:Case Management - Health ChecksUNANNOUNCEDTIME BEGAN:
09:25 AM
MET WITH:Lailo Matias, Administrator TIME COMPLETED:
11:35 AM
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On 06/20/2024 at 09:25 AM, Licensing Program Analyst (LPA) J. Clancy-Czuleger conducted an unannounced Health & Safety inspection. LPA met with Administrator Lailo Matias.

LPA toured facility including but not limited to the common areas, bathrooms, kitchens, bedrooms and backyard. Hot water temperature in common area temperature was at a comfortable degrees. There are 2-days of non-perishables and 7-days of perishable food supplies. Resident's medications were kept locked in the medication cabinet. Smoke and carbon monoxide detectors are combined and observed throughout the facility and the bedrooms. First-aid kit was complete. No accessible bodies of water were observed. Indoor and outdoor passageways were free of obstruction.

No deficiencies are cited on this date.

Exit interview conducted. A copy of this report provided.
SUPERVISOR'S NAME: Harpreet HumpalTELEPHONE: (510) 285-3928
LICENSING EVALUATOR NAME: Jill Clancy-CzulegerTELEPHONE: 510-286-4201
LICENSING EVALUATOR SIGNATURE:
DATE: 06/20/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/20/2024
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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