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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 079201037
Report Date: 02/05/2021
Date Signed: 02/05/2021 03:54:20 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:GREEN PASTURES RESIDENCES LLC - OAKMONT MANORFACILITY NUMBER:
079201037
ADMINISTRATOR:ENRIQUEZ, STEPHANIE NARESFACILITY TYPE:
740
ADDRESS:1408 OAKMONT PLTELEPHONE:
(925) 858-1870
CITY:PITTSBURGSTATE: CAZIP CODE:
94565
CAPACITY:6CENSUS: 0DATE:
02/05/2021
TYPE OF VISIT:Case Management - OtherANNOUNCEDTIME BEGAN:
02:40 PM
MET WITH:Stephanie and Jose Enriquez, AdministratorsTIME COMPLETED:
03:20 PM
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On 02/05/2021 at 2:40pm, Licensing Program Analyst, (LPA), L. Hall conducted a tele-visit Component III presentation through Facetime due to the shelter in place order directed by the Governor, on 09/03/2020 starting at 12:00pm. LPA met with Administrators, Stephanie and Jose Enriquez.

LPA presented Component III power point and discussed the regulations embodied in the power point. LPA observed the participant gained knowledge about running and maintaining the facility in accordance with regulations.

A license has not yet been granted for this facility. Licensure is subject to final review and approval by the Centralized Applications Bureau.

Exit interview conducted with Administrators. A copy provided by email.
SUPERVISOR'S NAME: Harpreet HumpalTELEPHONE: (510) 285-3928
LICENSING EVALUATOR NAME: Laura HallTELEPHONE: (510) 622-2024
LICENSING EVALUATOR SIGNATURE:

DATE: 02/05/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/05/2021
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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