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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 079201030
Report Date: 09/25/2024
Date Signed: 09/25/2024 02:49:10 PM

Document Has Been Signed on 09/25/2024 02:49 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:A&A HEALTH SERVICES SAN PABLOFACILITY NUMBER:
079201030
ADMINISTRATOR/
DIRECTOR:		RIDOLFI, ELEINA LFACILITY TYPE:
735
ADDRESS:13956 SAN PABLO AVETELEPHONE:
(510) 609-4040
CITY:SAN PABLOSTATE: CAZIP CODE:
94806
CAPACITY: 225CENSUS: 122DATE:
09/25/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:45 AM
MET WITH:PRISCELLA SAAVEDRA, FULFILLMENT PARTNERTIME VISIT/
INSPECTION COMPLETED:
10:40 AM
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On 09/25/2024 at 09:45 AM Licensing Program Analyst (LPA), Carol Fowler arrived unannounced to deliver findings of CCLD receiving an Unusual/Incident Report (UIR) for an incident on or around 06/21/2024. LPA met with Priscella Saavedra, Fulfillment Partner. Rajdeep Dhillon, Chief Compliance Officer arrived at 10:50AM.

This incident was investigated by the Department and was found unsubstantiated.

No deficiencies cited during this visit.
SUPERVISORS NAME: Bennett Fong
LICENSING EVALUATOR NAME: Carol Fowler
LICENSING EVALUATOR SIGNATURE: DATE: 09/25/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/25/2024
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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