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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 079201245
Report Date: 07/13/2023
Date Signed: 07/13/2023 12:52:36 PM

Document Has Been Signed on 07/13/2023 12:52 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
OAKLAND ASC, 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:
07/13/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
08:55 AM
MET WITH:Fe DimaanoTIME COMPLETED:
01:25 PM
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On 07/13/2023 at 08:55 AM, Licensing Program Analyst (LPA) J. Sampair arrived unannounced for this pre-licensing inspection. LPA informed Administrator (ADM) Fe Dimaano of the purpose of the visit.

LPA toured facility and completed the COMP III training with ADM.

Pre-Licensing deficiencies have been resolved. Pre-Licensing is now complete.

Exit interview conducted with ADM. A copy of this report provided for ADM by LPA via email.
SUPERVISORS NAME: Bennett Fong
LICENSING EVALUATOR NAME: James Sampair
LICENSING EVALUATOR SIGNATURE: DATE: 07/13/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/13/2023
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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