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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 079201217
Report Date: 11/30/2022
Date Signed: 11/30/2022 11:04:31 AM

Document Has Been Signed on 11/30/2022 11:04 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:RANGEL HOMEFACILITY NUMBER:
079201217
ADMINISTRATOR:RANGEL, ZYRIELFACILITY TYPE:
735
ADDRESS:26 WILLIAM WAYTELEPHONE:
(925) 219-5486
CITY:PITTSBURGSTATE: CAZIP CODE:
94565
CAPACITY: 4CENSUS: 0DATE:
11/30/2022
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Zyriel Rangel, AdministratorTIME COMPLETED:
10:15 AM
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On 11/30/2022 at 09:30AM, Licensing Program Analyst (LPA) L. Hall arrived announced to conduct Pre-licensing inspection. LPA met with Zyriel Rangel, Administrator and explained the purpose of the visit. Facility has fire clearance for four (4) ambulatory clients.

LPA inspected the facility inside and out including but not limited to the bedrooms, bathrooms, common living areas, kitchen, garage and back yard. The facility has a total of four (4) bedrooms and two (2) bathrooms. There is sufficient lighting around the facility. Clients' rooms are equipped with the beds, chairs, and lighting. Clients rooms have proper bedding and linens. Passageways and hallways are free of obstruction. Hot water temperature is measured at 120.7 degrees Fahrenheit. Fire extinguisher last serviced on 7/11/2022. Facility has locked cabinet for medications and sharps. Smoke detectors/carbon Monoxide detector are equipped and operable around the facility. First Aid kit was complete.

No Issues were noted during inspection. LPA observed that facility is ready to be licensed. This report will be submitted to the Central Applications Unit (CAU) and a final review of the application will be conducted. This facility is not yet licensed and is subject to final approval by CAU. Additional requirements may still be required.

Exit interview conducted and a copy of this report provided.
SUPERVISORS NAME: Harpreet Humpal
LICENSING EVALUATOR NAME: Laura Hall
LICENSING EVALUATOR SIGNATURE: DATE: 11/30/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/30/2022
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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