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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 079200085
Report Date: 12/11/2024
Date Signed: 12/11/2024 02:43:14 PM

Document Has Been Signed on 12/11/2024 02:43 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
CCLD Regional Office, 1515 CLAY STREET, STE. 310
OAKLAND, CA 94612
FACILITY NAME:MENONA DRIVE CARE HOMEFACILITY NUMBER:
079200085
ADMINISTRATOR/
DIRECTOR:		FLORENCIA FLORESFACILITY TYPE:
735
ADDRESS:4586 MENONA DRIVETELEPHONE:
(925) 303-2969
CITY:ANTIOCHSTATE: CAZIP CODE:
94531
CAPACITY: 6CENSUS: 0DATE:
12/11/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
02:15 PM
MET WITH:Florencia Flores, Administrator
Cherence Flores Stella		TIME VISIT/
INSPECTION COMPLETED:
04:30 PM
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On 12/11/24 at 2:15PM, Licensing Program Analyst (LPA) D Panlilio arrived unannounced to conduct an annual required inspection. LPA met with staff (ADM,S1) and explained the purpose of the visit.

LPA observed facility has no clients and that facility is undergoing complete interior renovation. ADM stated that they continue to pay the annual fees to keep the facility's license current. ADM stated she will notify CCL when the facility will start accepting new clients.

No deficiency observed during visit.

Exit interview conducted and a copy of this report provided.
SUPERVISORS NAME: Bennett Fong
LICENSING EVALUATOR NAME: Daisy Panlilio
LICENSING EVALUATOR SIGNATURE: DATE: 12/11/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/11/2024
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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