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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 079201106
Report Date: 12/15/2021
Date Signed: 12/15/2021 04:10:47 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:EASTBAY VILLASFACILITY NUMBER:
079201106
ADMINISTRATOR:SURIAO, MARINAFACILITY TYPE:
740
ADDRESS:1785 BILLINGS ROADTELEPHONE:
(925) 689-6551
CITY:CONCORDSTATE: CAZIP CODE:
94519
CAPACITY:6CENSUS: 4DATE:
12/15/2021
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
02:00 PM
MET WITH:Marina SuriaoTIME COMPLETED:
04:30 PM
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On 12/15/2021, Licensing Program Analysts (LPAs) L. Ibo, J. Clancy- Czuleger arrived unannounced to conduct a pre-licensing inspection due to a change of ownership. LPAs met with staff Marina Suriao (Applicant/Administrator for Eastbay Villas), LPAs called Administrator Leonila Bunyi to informed the purpose of the visit, per Administrator Leonila Bunyi she is not available, L. Bunyi gave permission to LPAs to read report and give copy of the report to Applicant Marina Suriao.


Component III was discussed with Applicant Marina Suriao.


LPAs observed that facility is ready to be licensed. This report will be submitted to the Central Applications Unit (CAU) and a final review of the application will be conducted. This facility is not yet licensed and is subject to final approval by CAU. Additional requirements may still be required.


Exit interview conducted with Applicant Marina Suriao and a copy of report was provided.
SUPERVISOR'S NAME: Harpreet HumpalTELEPHONE: (510) 285-3928
LICENSING EVALUATOR NAME: Leslie IboTELEPHONE: 510-286-4201
LICENSING EVALUATOR SIGNATURE:

DATE: 12/15/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/15/2021
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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