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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 079200994
Report Date: 12/14/2023
Date Signed: 12/14/2023 11:04:19 AM


Document Has Been Signed on 12/14/2023 11:04 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:ANGELS TOUCH CARE HOME, LLCFACILITY NUMBER:
079200994
ADMINISTRATOR:ROSS, LARUTHFACILITY TYPE:
740
ADDRESS:1653 SWALLOW WAYTELEPHONE:
(510) 725-2020
CITY:HERCULESSTATE: CAZIP CODE:
94547
CAPACITY:6CENSUS: 0DATE:
12/14/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
10:30 AM
MET WITH:LARUTH ROSS, LICENSEETIME COMPLETED:
11:30 AM
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On this day at 10:30 am, Licensing Program Analyst (LPA) Carol Fowler arrived to conduct a case management closure visit and met with Licensee Laruth Ross.

During the visit, LPA inspected the facility inside and out including but not limited to bedrooms, bathrooms, kitchen, dining area, living area and garage. There were no clients observed at the facility. Licensee states the clients have been moved to other facilities and one (1) moved home with family, the last client moved out on December 4, 2023. Licensee states she is retiring.

Licensee stated that she faxed a letter to CCLD on October 23, 2023 informing the Department of the facility closure, stating that facility is no longer interested in operating effective December 7, 2023. Original facility license was surrendered to LPA during the visit.
SUPERVISOR'S NAME: Bennett FongTELEPHONE: (510) -62-2621
LICENSING EVALUATOR NAME: Carol FowlerTELEPHONE: (510) 622-2715
LICENSING EVALUATOR SIGNATURE:
DATE: 12/14/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/14/2023
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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