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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 075601499
Report Date: 02/14/2023
Date Signed: 02/14/2023 12:21:36 PM


Document Has Been Signed on 02/14/2023 12:21 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:RELIEZ VALLEY CARE HOMEFACILITY NUMBER:
075601499
ADMINISTRATOR:MACDONALD, LEAHFACILITY TYPE:
740
ADDRESS:656 STERLING DRIVETELEPHONE:
(925) 370-6425
CITY:MARTINEZSTATE: CAZIP CODE:
94553
CAPACITY:6CENSUS: 4DATE:
02/14/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
10:40 AM
MET WITH:Leah MacDonald, AdministratorTIME COMPLETED:
11:10 AM
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On 2/14/2023 at 10:40AM, Licensing Program Analysts (LPAs) L. Alexander and G. Luk conducted an unannounced case management visit to amended reports originally dated 11/30/2022 and 1/17/2023. LPAs met with Caregiver Iluminada Rodriguez. Administrator, Leah MacDonald arrived at 11:01AM.

During visit, LPAs requested original reports that was given to facility on 11/30/2022 and 1/17/2023 to be mailed back to CCLD by 02/17/2023.


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: 02/14/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/14/2023
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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