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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 075601490
Report Date: 01/30/2024
Date Signed: 01/30/2024 12:59:31 PM


Document Has Been Signed on 01/30/2024 12:59 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:
01/30/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
12:30 PM
MET WITH:Lea Robes, CaregiverTIME COMPLETED:
01:10 PM
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On 01/30/2024 at 12:30PM, Licensing Program Analyst L. Alexander arrived unannounced to conduct a case management visit to deliver amended report originally dated 01/24/2024. LPA met with Caregiver, Lea Robes and informed her the reason for visit. Lea phoned Licensee/Administrator, Alberto Bernardino to inform. Alberto arrived at the facility approx. 20 mins later.

During visit, LPA obtained original report dated 01/24/2024 from Lea Robes.

No deficiencies are being cited on this date.

Exit interview conducted. A copy of this report provided.
SUPERVISOR'S NAME: Bennett FongTELEPHONE: (510) 725-7919
LICENSING EVALUATOR NAME: Lori Alexander-WashingtonTELEPHONE: (510) 285-3934
LICENSING EVALUATOR SIGNATURE:
DATE: 01/30/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/30/2024
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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