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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 079201109
Report Date: 12/09/2021
Date Signed: 12/09/2021 04:14:42 PM

Document Has Been Signed on 12/09/2021 04:14 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:DELTA RESIDENTIAL-RIDGE CRESTFACILITY NUMBER:
079201109
ADMINISTRATOR:BUSALACCHI, AARONFACILITY TYPE:
735
ADDRESS:80 RIDGE CREST COURTTELEPHONE:
(925) 679-1486
CITY:OAKLEYSTATE: CAZIP CODE:
94561
CAPACITY: 6CENSUS: 4DATE:
12/09/2021
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
03:10 PM
MET WITH:BUSALACCHI, AARONTIME COMPLETED:
04:40 PM
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On 12/9/2021 (Licensing Program Analyst) LPA L. Ibo conducted pre-licensing continuation requirement. LPA met with house manager Liza Tagpis, Administrator arrived around 3:45PM .

When LPA L.Ibo conducted pre-licensing on 11/12/2021, there were additional requirements that wasn't completed during the pre-licensing inspection which was the following:

Incomplete First Aid kit - completed
Sliding door blinds by the living room and dining area is broken and has some missing parts - completed
Carpet on the master’s bedroom has torn and stained - completed
Facility do not have night lights on the hallways and common bathrooms- completed
Facility do not have operational Flashlight with batteries- completed
3 minor clients live at the facility and need to be transferred - completed

Today, 12/9/2021 LPA verified that all requirements was met, 3 minor clients were moved to another facility and no longer live at DELTA RESIDENTIAL-RIDGE CREST therefore LPA recommends the facility for license.

The existing Administrator Aaron Busalachi has been an Administrator for multiple homes for many years. The facility was clean, all records were cleared.

This facility is not yet licensed and is subject to final approval by CAU. Additional requirements may still be required.

Exit interview conducted with Aaron BUSALACCHI, and a copy of this report provided.
SUPERVISORS NAME: Harpreet Humpal
LICENSING EVALUATOR NAME: Leslie Ibo
LICENSING EVALUATOR SIGNATURE: DATE: 12/09/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/09/2021
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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