<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 079200331
Report Date: 04/27/2023
Date Signed: 04/27/2023 03:01:07 PM


Document Has Been Signed on 04/27/2023 03:01 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:DREAN OF ANGEL CARE LLCFACILITY NUMBER:
079200331
ADMINISTRATOR:ANGIE ESPLANAFACILITY TYPE:
740
ADDRESS:274 STARLING WAYTELEPHONE:
(510) 313-0361
CITY:HERCULESSTATE: CAZIP CODE:
94547
CAPACITY:6CENSUS: 1DATE:
04/27/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
12:30 PM
MET WITH:Jean Felix House Manager TIME COMPLETED:
03:15 PM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
On 04/27/2023 at 12:30PM Licensing Program Analyst (LPA) C. Fowler arrived to conducted an unannounced annual required visit. LPA met with Jean Felix, House Manager and explained the purpose of the visit. House Manager informed LPA that the facility will be ceasing operation on 4/30/2023.

The last resident (R1) will be transferred to a licensed facility in another region. LPA observed that 2 of 3 residents have been transferred to other licensed facilities list was provided along with contact numbers for residents. During visit LPA contacted R1's Case Manager (CM) and spoke with her about R1's new arrangements and transportation. LPA also contacted Licensee via phone call, there was no answer LPA left a voicemail, and informed House Manager of the proper procedure for closing a facility and to convey the message to the Licensee.

LPA C. Fowler collected documents pertinent to the case management.

No deficiencies issued during the visit.

Exit interview conducted and a copy of this report was provided.
SUPERVISOR'S NAME: Bennett FongTELEPHONE: (510) -62-2621
LICENSING EVALUATOR NAME: Carol FowlerTELEPHONE: (510) 622-2715
LICENSING EVALUATOR SIGNATURE:
DATE: 04/27/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/27/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 1