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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 075601490
Report Date: 08/22/2023
Date Signed: 08/22/2023 01:30:52 PM


Document Has Been Signed on 08/22/2023 01:30 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:MAUREEN HOUSEFACILITY NUMBER:
075601490
ADMINISTRATOR:JOSE MICHAEL TORIOFACILITY TYPE:
740
ADDRESS:590 MAUREEN LANETELEPHONE:
(925) 818-6536
CITY:PLEASANT HILLSTATE: CAZIP CODE:
94523
CAPACITY:6CENSUS: 6DATE:
08/22/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
10:33 AM
MET WITH:Lea Robes, CaregiverTIME COMPLETED:
11:15 AM
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On 08/22/2023 at 10:33 AM Licensing Program Analysts (LPAs) L. Alexander and L. Fontanilla conducted an unannounced Case Management visit to amend a Complaint Report from the previous visit on 08/03/2023. LPAs met with Caregiver, Lea Robes and explained the purpose of the visit.

A copy of the amended report was provided to Albert Bernardino.
SUPERVISOR'S NAME: Bennett FongTELEPHONE: (510) 725-7919
LICENSING EVALUATOR NAME: Lori Alexander-WashingtonTELEPHONE: (510) 285-3934
LICENSING EVALUATOR SIGNATURE:
DATE: 08/22/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/22/2023
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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