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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 079200599
Report Date: 10/16/2024
Date Signed: 10/16/2024 12:34:58 PM

Document Has Been Signed on 10/16/2024 12:34 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:ROSE'S GARDEN ADULT RESIDENTIAL 2FACILITY NUMBER:
079200599
ADMINISTRATOR/
DIRECTOR:		JOSE L NUNES, JRFACILITY TYPE:
735
ADDRESS:1617 MONTEREY DRIVETELEPHONE:
(925) 864-7564
CITY:ANTIOCHSTATE: CAZIP CODE:
94509
CAPACITY: 6CENSUS: 6DATE:
10/16/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
12:05 PM
MET WITH:Jose Nunes, AdministratorTIME VISIT/
INSPECTION COMPLETED:
12:45 PM
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On 10/16/2024 at 12:05pm, Licensing Program Analyst (LPA) L. Hall conducted an unannounced Case Management visit regarding an incident that was reported to CCLD on 10/9/2024. LPA met with Jose Nunes, Administrator, and explained the purpose of the visit.

The incident occurred on 10/7/2024, which involved C1 AWOL'g. S1 stated C1 was having aggressive behaviors towards S2. While S2 was trying to de-escalate the situation C1 forced his way through side gate. S1 stated C1 only went a passed a couple of houses down the street. At the same time S3 had been called and was in route. S3 arrived and observed C1, asked C1 to get into the vehicle, which C1 complied. C1 stated he did not want to go into the facility. S3 took C1 to the restaurant with her. C1 calmed down while at the restaurant.

S1 stated C1 has an AWOL plan. S1 emailed LPA plan.

No deficiencies issued during the visit.

Exit interview conducted and a copy of this report was provided.
SUPERVISORS NAME: Harpreet Humpal
LICENSING EVALUATOR NAME: Laura Hall
LICENSING EVALUATOR SIGNATURE: DATE: 10/16/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/16/2024
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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