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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 079201117
Report Date: 12/17/2021
Date Signed: 12/20/2021 08:38:41 AM

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:ANGEL'S LOVE RCFE 2FACILITY NUMBER:
079201117
ADMINISTRATOR:BADEO, MARCELINAFACILITY TYPE:
740
ADDRESS:2030 TIOGA PASS WAYTELEPHONE:
(925) 876-0605
CITY:ANTIOCHSTATE: CAZIP CODE:
94531
CAPACITY:6CENSUS: 4DATE:
12/17/2021
TYPE OF VISIT:OfficeUNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Marcelina BadeoTIME COMPLETED:
10:58 AM
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Component II completion: Unsuccessful

Facility Type: RCFE
Application Type: Initial
Capacity: 6
Census (if any clients in care): 4
COMP II Participants: Marcelina Badeo
Interview Method: Telephone interview

On December 17, 2021 at 10:00 AM, Administrator participated in COMP II. Identification of the applicant and administrator was verified through interview questions based on photo ID and other identifying personal information. Administrator did not provide sufficient knowledge the program and the California Code Title 22 Regulations. Component II will be rescheduled.

Exit interview conducted with Administrator. Analyst sent copy of report via email to Administrator to sign and return LIC 809. Photo ID was verified via interview with copy of ID provided prior to call.
SUPERVISOR'S NAME: Julio MontesTELEPHONE: (510) 286-0518
LICENSING EVALUATOR NAME: Celia PhomphachanhTELEPHONE: (510)286-4201
LICENSING EVALUATOR SIGNATURE:

DATE: 12/17/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/17/2021
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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