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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 075601281
Report Date: 09/10/2024
Date Signed: 09/10/2024 04:05:35 PM


Document Has Been Signed on 09/10/2024 04:05 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
CCLD Regional Office, 1515 CLAY STREET, STE. 310
OAKLAND, CA 94612



FACILITY NAME:QCARE RESIDENTIAL FACILITY IIFACILITY NUMBER:
075601281
ADMINISTRATOR:CUNANAN, JOAQUINFACILITY TYPE:
740
ADDRESS:4363 FAIRWOOD DRIVETELEPHONE:
(925) 676-8727
CITY:CONCORDSTATE: CAZIP CODE:
94521
CAPACITY:6CENSUS: 6DATE:
09/10/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
03:51 PM
MET WITH:Joaquin Cunana, AdministratorTIME COMPLETED:
04:20 PM
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While conducting an annual LPA K. Nguyen identify S1 was not associated on Guardian. Administrator showed LPA proof of S1 background clearance with the ID 4600392499. Administrator explained that he was working with Guardian staff to figure out this situation, and Guardian is aware of the association of S1.

Require documents from Administrator:

Proof of association before S1 start work.

No deficiency cited. Exit interview and a copy of report is provided.

SUPERVISOR'S NAME: Bennett FongTELEPHONE: (510) 725-7919
LICENSING EVALUATOR NAME: Kelly NguyenTELEPHONE: (510) 915-8702
LICENSING EVALUATOR SIGNATURE:
DATE: 09/10/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/10/2024
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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