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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 075601264
Report Date: 08/01/2023
Date Signed: 08/01/2023 02:03:45 PM


Document Has Been Signed on 08/01/2023 02:03 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
OAKLAND ASC, 1515 CLAY STREET, STE. 310
OAKLAND, CA 94612



FACILITY NAME:TENDER TOUCH RESIDENTIAL CARE HOME IIIFACILITY NUMBER:
075601264
ADMINISTRATOR:CRUZ, ESTRELLITA S.FACILITY TYPE:
740
ADDRESS:2130 DORSCH ROADTELEPHONE:
(925) 256-6879
CITY:WALNUT CREEKSTATE: CAZIP CODE:
94598
CAPACITY:6CENSUS: 5DATE:
08/01/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
09:45 AM
MET WITH:Caregiver Cherrie BragaTIME COMPLETED:
02:30 PM
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On 08/01/2023 at 9:45 AM, Licensing Program Analyst (LPA) J. Sampair arrived unannounced for a Prelicensing visit. Upon entry, LPA explained purpose of the visit to Caregiver Cherrie Braga in-person and Administrator (ADM) Fe Dimaano over the phone.

During this visit, the LPA inspected the facility's physical plant (inside and outside), checked postings, and reviewed facility and resident records. The facility is fully in compliance with Title 22 regulations.

No citations issued during visit.

Pre-Licensing deficiencies have been resolved. Pre-Licensing is now complete.

Exit interview conducted with Caregiver Cherrie Braga. A copy of this report provided for ADM by LPA via email.
SUPERVISOR'S NAME: Bennett FongTELEPHONE: (510) -62-2621
LICENSING EVALUATOR NAME: James SampairTELEPHONE: (510) 286-4201
LICENSING EVALUATOR SIGNATURE:
DATE: 08/01/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/01/2023
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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