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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 079201008
Report Date: 09/04/2024
Date Signed: 09/04/2024 03:59:04 PM


Document Has Been Signed on 09/04/2024 03:59 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:TEMESCAL RESIDENTIAL CARE HOME CORP.FACILITY NUMBER:
079201008
ADMINISTRATOR:MELANIO, ANDRES JR JAGARAPFACILITY TYPE:
740
ADDRESS:4580 TEMESCAL COURTTELEPHONE:
(925) 303-2959
CITY:ANTIOCHSTATE: CAZIP CODE:
94531
CAPACITY:6CENSUS: 0DATE:
09/04/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
03:00 PM
MET WITH:Alan Trias, Son of Owner
Alex Trias, Owner		TIME COMPLETED:
04:00 PM
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On 09/04/24 at 3PM, Licensing Program Analyst (LPA) Daisy Panlilio conducted an unannounced visit and met with owner's son (S1). LPA explained the purpose of the visit and spoke with property owner (PO) on the phone who stated that the former facility operators relocated all residents early in the year 2024 and failed to properly close the facility with CCL.

(S1) stated that the facility has ceased operation since May 2024 and is now his primary private residence. PO stated that he sent CCL a written letter that he is no longer renewing the facility operator's lease effective April 2024.

LPA observed no residents at the home during visit. LPA also observed all RCFE signages removed from the facility.

LPA advised S1 facility will be processed for closure effective 09/04/24.
SUPERVISOR'S NAME: Bennett FongTELEPHONE: (510) 622-2621
LICENSING EVALUATOR NAME: Daisy PanlilioTELEPHONE: (510) 286-4201
LICENSING EVALUATOR SIGNATURE:
DATE: 09/04/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/04/2024
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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