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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 075601427
Report Date: 09/24/2021
Date Signed: 09/27/2021 08:21:55 AM

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:SAINT MARTHA CARE HOMEFACILITY NUMBER:
075601427
ADMINISTRATOR:REYES, VIRGIL T.FACILITY TYPE:
740
ADDRESS:1760 LANDANA DRIVETELEPHONE:
(925) 349-9601
CITY:CONCORDSTATE: CAZIP CODE:
94519
CAPACITY:6CENSUS: 0DATE:
09/24/2021
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
01:45 PM
MET WITH:Virgil ReyesTIME COMPLETED:
02:30 PM
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On this day, Licensing Program Analyst (LPA) Luisa Fontanilla conducted a facility closure televisit via Facetime and met with Administrator Virgil Reyes. LPA explained to Administrator the purpose of the visit.

The last resident was moved out of the facility in March 2021. Administrator states that the four bedrooms are currently being rented out. Administrator also states that most of the renters are actively working except for the couple who are both retired. Administrator showed LPA all the rooms including the garage. LPA interviewed 4 out of 5 renters. LPA observed that all renters interviewed appeared to be independent and not needing any care.

Administrator states that the facility license will be surrendered to the Oakland CCL office.

Exit interview conducted with Administrator.

A copy of this report was provided to Administrator via email.
SUPERVISOR'S NAME: Yvonne Flores-LariosTELEPHONE: (510) 286-0517
LICENSING EVALUATOR NAME: Luisa FontanillaTELEPHONE: (510) 286-7147
LICENSING EVALUATOR SIGNATURE:

DATE: 09/24/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/24/2021
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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