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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 079201059
Report Date: 05/19/2021
Date Signed: 05/20/2021 12:49:01 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:CARE 4 ONE INCFACILITY NUMBER:
079201059
ADMINISTRATOR:ELEGADO, LIZA JAY S.FACILITY TYPE:
740
ADDRESS:3938 COWELL RDTELEPHONE:
(925) 464-3891
CITY:CONCORDSTATE: CAZIP CODE:
94518
CAPACITY:6CENSUS: 6DATE:
05/19/2021
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
02:30 PM
MET WITH:Liza ElegadoTIME COMPLETED:
04:00 PM
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Licensing Program Analysts (LPAs) Luisa Fontanilla and Carol Fowler conducted a Component lll Zoom televisit in connection with pre licensing for this facility and met with Applicant Liza Elegado.

During the Component lll power point presentation, LPAs provided Elegado information to operate the facility within Title 22 regulatory compliance as well as how to avoid common problem areas. Elegado confirmed understanding of regulations discussed.

Exit interview was conducted and a copy of this report was provided to Applicant via email.
SUPERVISOR'S NAME: Yvonne Flores-LariosTELEPHONE: (510) 286-0517
LICENSING EVALUATOR NAME: Luisa FontanillaTELEPHONE: (510) 286-7147
LICENSING EVALUATOR SIGNATURE:

DATE: 05/19/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/19/2021
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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