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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 079201099
Report Date: 12/07/2023
Date Signed: 12/07/2023 12:44:45 PM

Document Has Been Signed on 12/07/2023 12:44 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:GARCIA'S PLACE, INC.FACILITY NUMBER:
079201099
ADMINISTRATOR:OVILIO BARRIOS GARCIAFACILITY TYPE:
735
ADDRESS:1712 SAN JOSE DRIVETELEPHONE:
(925) 775-4200
CITY:ANTIOCHSTATE: CAZIP CODE:
94509
CAPACITY: 4CENSUS: 4DATE:
12/07/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
12:20 PM
MET WITH:Loida Gavilan, LicenseeTIME COMPLETED:
12:50 PM
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On 12/7/2023 at 12:20pm, Licensing Program Analyst (LPA) L. Hall conducted an unannounced Case Management visit following up on a prior case management visit on 8/25/2023. LPA met with Loida Gavilan, Licensee and explained the purpose of the visit.

LPA toured bedroom with Licensee where C1 resided. LPA observed window was facing front of the home with an alarm located at the bottom of the window. Licensee stated that there was a larger alarm on the inside and outside of the window at the time of the incident and showed LPA the alarm. Licensee stated that C1 had disarmed the alarm at the time of AWOL.

No deficiencies cited during visit.

Exit interview conducted and a copy of this report provided.
SUPERVISORS NAME: Harpreet Humpal
LICENSING EVALUATOR NAME: Laura Hall
LICENSING EVALUATOR SIGNATURE: DATE: 12/07/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/07/2023
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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