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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 075601406
Report Date: 04/03/2021
Date Signed: 04/03/2021 12:59:14 PM

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:LA CASA VERDEFACILITY NUMBER:
075601406
ADMINISTRATOR:ALCANTARA, LEONARDOFACILITY TYPE:
740
ADDRESS:1405 CAMINO VERDETELEPHONE:
(925) 285-5078
CITY:WALNUT CREEKSTATE: CAZIP CODE:
94597
CAPACITY:6CENSUS: 0DATE:
04/03/2021
TYPE OF VISIT:Case Management - Health ChecksUNANNOUNCEDTIME BEGAN:
12:00 PM
MET WITH:Leonardo Alcantara, AdministratorTIME COMPLETED:
12:45 PM
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Licensing Program Analyst (LPA) Praveen Singh conducted a Case Management health and safety tele-inspection with Administrator Leonardo Alcantara, in relation to the Department receiving a priority 2 complaint. This inspection was conducted via video-conference due to the present shelter in place order by the Governor.

During the tele-inspection, LPA was informed that the facility has been vacant for approximately one month, although the facility is maintained for future admissions. LPA toured the facility, including but not limited to resident bedrooms, bathrooms, living room, dining room, kitchen, and outdoor areas. LPA observed there was a locked cabinet for medications and cleaning supplies were kept locked in a garage cabinet. LPA observed passageways appeared to be free of obstruction. LPA was informed by Administrator that everything was in good repair and no disruption to utilities.

No deficiencies cited during inspection. Exit interview conducted and a copy of the report emailed to Administrator.
SUPERVISOR'S NAME: Julio MontesTELEPHONE: (510) 286-0518
LICENSING EVALUATOR NAME: Praveen SinghTELEPHONE: (510) 622-2625
LICENSING EVALUATOR SIGNATURE:

DATE: 04/03/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/03/2021
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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