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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 079200212
Report Date: 01/07/2025
Date Signed: 01/07/2025 11:15:30 AM

Document Has Been Signed on 01/07/2025 11:15 AM - 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:RES SUCCESSFACILITY NUMBER:
079200212
ADMINISTRATOR/
DIRECTOR:		FABIOLA DELA TORREFACILITY TYPE:
775
ADDRESS:2980 RAILROAD AVENUETELEPHONE:
(925) 473-9552
CITY:PITTSBURGSTATE: CAZIP CODE:
94565
CAPACITY: 72CENSUS: 23DATE:
01/07/2025
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:25 AM
MET WITH:Fabiola Dela Torre, Program ManagerTIME VISIT/
INSPECTION COMPLETED:
11:25 AM
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On 1/7/2025 at 10:10am, Licensing Program Analyst (LPA) L. Hall arrived unannounced to conduct Case Management visit regarding an incident that was reported to CCLD on 1/6/2025. LPA met with Fabiola Dela Torre and Kenya Criss, Program Managers, and explained the reason for the visit.


Incident report for C1 and C2 was sent on 1/3/2025. LPA interviewed staff, obtained and reviewed the staff schedule and client roster for the day of the incident. Both S2 and S3 stated that C1 and C2 had a verbal argument with C3. C1 and C2 decided to go on the balcony as normal. S3 went to check on C1 and C2 and observed the interaction. LPA reviewed staff schedule and client roster and facility had met the staff-client ratio. Both C1 and C2 are not attending the day program until and interdisciplinary team meeting can be held for both.

No citations are being issued on this date.

Exit interview conducted and a copy of this report provided.
SUPERVISORS NAME: Harpreet Humpal
LICENSING EVALUATOR NAME: Laura Hall
LICENSING EVALUATOR SIGNATURE: DATE: 01/07/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/07/2025
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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