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Department of
SOCIAL SERVICES
Community Care Licensing
FACILITY EVALUATION REPORT
Facility Number:
079200525
Report Date:
11/15/2024
Date Signed:
11/18/2024 04:24:21 PM
Document Has Been Signed on
11/18/2024 04:24 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
OAKLAND ASC
,
1515 CLAY STREET, STE. 310
OAKLAND
,
CA
94612
FACILITY NAME:
CARING ANGELS CARE HOME
FACILITY NUMBER:
079200525
ADMINISTRATOR/
DIRECTOR:
JOHNNY BARROSA
FACILITY TYPE:
740
ADDRESS:
3107 DEL OCEANO DRIVE
TELEPHONE:
(925) 943-5087
CITY:
LAFAYETTE
STATE:
CA
ZIP CODE:
94549
CAPACITY:
6
CENSUS:
6
DATE:
11/15/2024
TYPE OF VISIT:
Case Management - Annual Continuation
UNANNOUNCED
TIME VISIT/
INSPECTION BEGAN:
02:50 PM
MET WITH:
Johhny Barrosa, Administrator
TIME VISIT/
INSPECTION COMPLETED:
05:45 PM
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SUPERVISORS NAME
:
Bennett Fong
LICENSING EVALUATOR NAME
:
David Doidge
LICENSING EVALUATOR SIGNATURE
:
DATE:
11/18/2024
I acknowledge receipt of this form and understand my
licensing
appeal rights as
explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE:
11/18/2024
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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