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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 079201008
Report Date: 10/19/2020
Date Signed: 10/19/2020 12:54:00 PM

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) 813-5700
CITY:ANTIOCHSTATE: CAZIP CODE:
94531
CAPACITY:6CENSUS: 3DATE:
10/19/2020
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
10:55 AM
MET WITH:Andres Melanios Jr, Administrator/ApplicantTIME COMPLETED:
12:15 PM
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On 10/19/20 at 10:55 AM, LPA D Panlilio completed a Component III presentation with Administrator/Applicant while conducting a Face-time pre-licensing tele-visit at the facility.
Administrator/Applicant was not physically available to sign this report due to COVID-19 shelter in place order by the governor.

LPA discussed the common pitfalls of RCFE facility operation, CA Title 22 Regulations, mitigation efforts/reporting requirements, COVID-19 PINs and CDC/DPH protocols in managing the COVID-19 pandemic during this time.

Administrator/Applicant agreed to comply with above requirements and contact CCLD with any issues as necessary.

Exit interview conducted and a copy of this report provided by email to Administrator/Applicant.
SUPERVISOR'S NAME: Rajind BasiTELEPHONE: (510) 286-4201
LICENSING EVALUATOR NAME: Daisy PanlilioTELEPHONE: (510) 286-4201
LICENSING EVALUATOR SIGNATURE:

DATE: 10/19/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/19/2020
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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