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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 079201142
Report Date: 02/22/2022
Date Signed: 02/22/2022 11:43:44 AM

Document Has Been Signed on 02/22/2022 11:43 AM - 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:EMMAUS HOMECARE INC.FACILITY NUMBER:
079201142
ADMINISTRATOR:BALMEO, MARCEL & QUENNIEFACILITY TYPE:
740
ADDRESS:3203 MUNRAS PLACETELEPHONE:
(650) 771-7909
CITY:SAN RAMONSTATE: CAZIP CODE:
94583
CAPACITY: 6CENSUS: 0DATE:
02/22/2022
TYPE OF VISIT:Case Management - OtherANNOUNCEDTIME BEGAN:
11:05 AM
MET WITH:Quennie Balemo, Licensee/AdministratorTIME COMPLETED:
11:55 AM
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On 2/22/2022 at 11:05 AM, Licensing Program Analysts (LPAs) LPAs L. Francisco and K. Nguyen conducted a face to face Component III presentation. LPAs met with Licensees Quennie Balmeo and Marcel Balmeo.

LPAs presented Component III power point and discussed the regulations embodied in the power point. LPAs observed the two participants gained knowledge about running and maintaining the facility in accordance with regulations.

Exit interview conducted and a copy of this report provided.
SUPERVISORS NAME: Harpreet Humpal
LICENSING EVALUATOR NAME: Lizette Francisco
LICENSING EVALUATOR SIGNATURE: DATE: 02/22/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/22/2022
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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