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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 079201245
Report Date: 06/23/2023
Date Signed: 06/23/2023 05:59:09 PM


Document Has Been Signed on 06/23/2023 05:59 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:VILLA NUEVA CARE HOME 2FACILITY NUMBER:
079201245
ADMINISTRATOR:VILLANUEVA, MYLIN PERDIGUEFACILITY TYPE:
740
ADDRESS:2053 DORSCH ROADTELEPHONE:
(925) 947-1421
CITY:WALNUT CREEKSTATE: CAZIP CODE:
94598
CAPACITY:6CENSUS: 5DATE:
06/23/2023
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
08:35 AM
MET WITH:Fe DimaanoTIME COMPLETED:
06:15 PM
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On 06/23/2023 at 08:35 AM, Licensing Program Analyst (LPA) J. Sampair arrived unannounced to conduct an Annual Inspection. Upon entry, LPA stated the purpose of the visit to Staff Members Purificacion Mapa and Manuel Baldeo. Administrator (ADM) Fe Dimaano arrived at approximately 9:00 AM.

Pre-Licensing is incomplete with deficiencies to be resolved by 07/23/2023. A follow up Pre-licensure LIC809 will be generated upon resolution of deficiencies.

Exit interview conducted with ADM. A copy of this report provided by LPA via email.
SUPERVISOR'S NAME: Harpreet HumpalTELEPHONE: (510) 285-3928
LICENSING EVALUATOR NAME: James SampairTELEPHONE: (510) 286-4201
LICENSING EVALUATOR SIGNATURE:
DATE: 06/23/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/23/2023
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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