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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 075601425
Report Date: 06/23/2023
Date Signed: 06/23/2023 02:33:04 PM


Document Has Been Signed on 06/23/2023 02:33 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
E BAY DELTA AC/SC, 1515 CLAY STREET, STE. 310
OAKLAND, CA 94612



FACILITY NAME:CRUSE HOUSE ALOHAFACILITY NUMBER:
075601425
ADMINISTRATOR:REYES, VIRGIL T.FACILITY TYPE:
740
ADDRESS:1850 MARINA COURTTELEPHONE:
(925) 338-2056
CITY:CONCORDSTATE: CAZIP CODE:
94520
CAPACITY:6CENSUS: 6DATE:
06/23/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
01:30 PM
MET WITH:Charmaine Cruz, AdministratorTIME COMPLETED:
02:45 PM
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On 6/23/2023 at 1:30 PM, Licensing Program Analyst (LPA) P. Watson arrived unannounced to conducted a Case Management visit. LPA met with Administrator, Charmaine Cruz, and explained that the purpose of the visit was due to LPA being informed that the facility property was sold July 25, 2022, though LPA had not received any notice from the facility of a change of ownership or Administrator.

LPA spoke to the new Administrator Charmaine, Charmaine informed LPA that Licensee sent the proper documents to the Department during the process of them selling the property. LPA asked that Administrator send those documents via email. LPA then explained the change of ownership process and informed them that a request for change of administrator needs to be done if they will be the main administrator. Charmaine stated they are in the process of obtaining their own license and will continue to operate this facility until they completed the change.


Exit interview was conducted and a copy of this report provided.
SUPERVISOR'S NAME: Yvonne Flores-LariosTELEPHONE: (510) 725-7926
LICENSING EVALUATOR NAME: Paris WatsonTELEPHONE: (510) 622-2625
LICENSING EVALUATOR SIGNATURE:
DATE: 06/23/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/23/2023
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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