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Department of
SOCIAL SERVICES
Community Care Licensing
FACILITY EVALUATION REPORT
Facility Number:
079201110
Report Date:
02/20/2024
Date Signed:
02/20/2024 01:35:51 PM
Document Has Been Signed on
02/20/2024 01:35 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:
CATERED CARE
FACILITY NUMBER:
079201110
ADMINISTRATOR:
GUTIERREZ, JONATHAN
FACILITY TYPE:
740
ADDRESS:
1312 5TH AVE
TELEPHONE:
(925) 286-2221
CITY:
CONCORD
STATE:
CA
ZIP CODE:
94518
CAPACITY:
4
CENSUS:
0
DATE:
02/20/2024
TYPE OF VISIT:
Case Management - Other
UNANNOUNCED
TIME BEGAN:
01:20 PM
MET WITH:
Jonathan Gutierrez, Licensee
TIME COMPLETED:
01:45 PM
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Licensing Program Analyst (LPA) J Clancy-Czuleger arrived to the facility announced to confirm that the facility is closed and is no longer in operation. LPA received notification that the facility will be closing.
Upon arrival at the facility LPA was met by Licensee Jonathan Gutierrez. The LPA walked around the facility inside and out and confirmed there was no residents at the facility. LPA was not able to collected the original copy of the License at this time.
Exit interview conducted and a copy of this report provided.
SUPERVISOR'S NAME:
Harpreet Humpal
TELEPHONE:
(510) 285-3928
LICENSING EVALUATOR NAME:
Jill Clancy-Czuleger
TELEPHONE:
510-286-4201
LICENSING EVALUATOR SIGNATURE:
DATE:
02/20/2024
I acknowledge receipt of this form and understand my
licensing
appeal rights as
explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE:
02/20/2024
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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