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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 079201117
Report Date: 01/05/2022
Date Signed: 01/05/2022 12:55:08 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: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: 3DATE:
01/05/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH:Marcelina Badeo, ApplicantTIME COMPLETED:
01:20 PM
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During the pre-licensing inspection on 01/05/22, Licensing Program Analyst (LPA) Daisy Panlilio conducted a Component lll presentation with applicant.

During the Component lll presentation, LPA provided applicant information on how to operate the facility within Title 22 regulatory compliance as well as how to avoid common problem areas. Applicant confirmed understanding of regulations discussed.

Exit interview conducted and a copy of this report was provided to applicant via email.
SUPERVISOR'S NAME: Bennett FongTELEPHONE: (510) 622-2621
LICENSING EVALUATOR NAME: Daisy PanlilioTELEPHONE: (510) 286-4201
LICENSING EVALUATOR SIGNATURE:

DATE: 01/05/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/05/2022
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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