<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 075601441
Report Date: 05/03/2024
Date Signed: 05/03/2024 12:14:16 PM


Document Has Been Signed on 05/03/2024 12:14 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:HARMONY HOME CAREFACILITY NUMBER:
075601441
ADMINISTRATOR:LINGBANAN, VICTORIAFACILITY TYPE:
740
ADDRESS:1621 THIRD AVENUETELEPHONE:
(925) 934-8827
CITY:WALNUT CREEKSTATE: CAZIP CODE:
94597
CAPACITY:22CENSUS: 16DATE:
05/03/2024
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
11:10 AM
MET WITH:Victoria Lingbanan, Licensee/Administrator TIME COMPLETED:
12:20 PM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
On 05/03/2024 at 11:10 AM, Licensing Program Analyst (LPA) Lori Alexander arrived unannounced to conduct a Case Management visit. LPA met with Licensee/Administrator, Victoria Lingbanan, and explained the purpose of the visit.

Back on 04/25/2024 during Plan of Correction (POC) Inspection visit, LPA L. Alexander assessed civil penalties due to deficiencies not cleared for CCR 87303(a). On 04/26/2024 Administrator and Licensees, Johnny and Victoria Lingbanan, submitted photos of the side and back yards.

On 05/03/2024 LPA L. Alexander toured the outside backyards with Johnny Lingbanan and observed that all the excess items in the back yards were removed. LPA L. Alexander observed that the yard was cleaned.

Assessing civil penalties will stop on 04/25/2024. No deficiencies issued during the visit.

Exit interview conducted and a copy of this report was provided.
SUPERVISOR'S NAME: Bennett FongTELEPHONE: (510) 725-7919
LICENSING EVALUATOR NAME: Lori Alexander-WashingtonTELEPHONE: (510) 285-3934
LICENSING EVALUATOR SIGNATURE:
DATE: 05/03/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/03/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 1