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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 079201034
Report Date: 05/05/2023
Date Signed: 05/05/2023 10:09:56 AM


Document Has Been Signed on 05/05/2023 10:09 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:AMIABLE CARE HOMEFACILITY NUMBER:
079201034
ADMINISTRATOR:ALIPING, JOELFACILITY TYPE:
740
ADDRESS:5180 VALLEY VIEW ROADTELEPHONE:
(510) 598-5272
CITY:EL SOBRANTESTATE: CAZIP CODE:
94803
CAPACITY:6CENSUS: 0DATE:
05/05/2023
TYPE OF VISIT:Case Management - OtherANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Joel Aliping, AdministratorTIME COMPLETED:
10:20 AM
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On 05/05/23 at 9:00 AM, Licensing Program Analyst (LPA) L. Holmes conducted an announced Case Management visit for a facility closure. Upon arrival, LPA met with Joel Aliping, Administrator.

On 05/03/23, ADM informed LPA by telephone of his intention to surrender the facility license. The facility was licensed 04/05/21, and there were never any residents admitted. LPA toured the facility including, but not limited to common areas, bathroom, bedrooms, kitchen, and backyard. There are not any residents present. LPA to submit documentation for closure and will advise ADM upon completion.

Exit interview conducted and report provided to ADM.
SUPERVISOR'S NAME: Yvonne Flores-LariosTELEPHONE: (510) 286-0517
LICENSING EVALUATOR NAME: Lisha HolmesTELEPHONE: 510-286-4201
LICENSING EVALUATOR SIGNATURE:
DATE: 05/05/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/05/2023
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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