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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 075601464
Report Date: 08/17/2021
Date Signed: 08/17/2021 01:45:48 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:TENDER LOVING CAREFACILITY NUMBER:
075601464
ADMINISTRATOR:KARAN, DAVITRIFACILITY TYPE:
740
ADDRESS:1689 HEATHERWOOD DRIVETELEPHONE:
(925) 267-3683
CITY:PITTSBURGSTATE: CAZIP CODE:
94565
CAPACITY:6CENSUS: 0DATE:
08/17/2021
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH:Davitri Karan, LicenseeTIME COMPLETED:
01:50 PM
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On 8/17/2021 at 01:00PM Licensing Program Analyst (LPA) L. Hall conducted an unannounced Case Management visit regarding closure of facility. LPA met with Davitri Karan, licensee and explained the purpose of the visit.

LPA did not observe any residents at the facility. Licensee stated that facility had only one (1) resident for two (2) years. Licensee stated that Resident now resides at a facility in Concord, CA. Resident left the facility at the beginning of May 2021. Licensee surrendered license to LPA.

No deficiencies issued during the visit.

Exit interview conduct and a copy of this report provided.
SUPERVISOR'S NAME: Harpreet HumpalTELEPHONE: (510) 285-3928
LICENSING EVALUATOR NAME: Laura HallTELEPHONE: (510) 622-2024
LICENSING EVALUATOR SIGNATURE:

DATE: 08/17/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/17/2021
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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