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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 079201188
Report Date: 09/29/2023
Date Signed: 09/29/2023 02:38:03 PM

Document Has Been Signed on 09/29/2023 02:38 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:EL REY HOME, THEFACILITY NUMBER:
079201188
ADMINISTRATOR:HAMILTON, LORELLFACILITY TYPE:
740
ADDRESS:2717 EL REY STREETTELEPHONE:
(925) 501-0235
CITY:ANTIOCHSTATE: CAZIP CODE:
94509
CAPACITY: 3CENSUS: 0DATE:
09/29/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
02:10 PM
MET WITH:Lorell Hamilton, AdministratorTIME COMPLETED:
02:40 PM
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On 09/29/23 at 2:10 PM, LPA D Panlilio conducted an unannounced required annual inspection at the facility. Upon arrival, LPA rang the door bell three times and knocked on the front door. There was no answer. LPA spoke with administrator on the phone who stated that the facility has no residents and that she has applied to convert the RCFE into an ARF facility. This is an attempted visit by LPA.

Administrator was not available to sign the report today.
SUPERVISORS NAME: Bennett Fong
LICENSING EVALUATOR NAME: Daisy Panlilio
LICENSING EVALUATOR SIGNATURE: DATE: 09/29/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/29/2023
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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