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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 079201253
Report Date: 05/15/2023
Date Signed: 05/15/2023 12:32:48 PM

Document Has Been Signed on 05/15/2023 12:32 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:FUSCHIA COURT HOMEFACILITY NUMBER:
079201253
ADMINISTRATOR:ROSELLON, EDGARDOFACILITY TYPE:
735
ADDRESS:50 FUSCHIA CTTELEPHONE:
(925) 818-5890
CITY:OAKLEYSTATE: CAZIP CODE:
94561
CAPACITY: 6CENSUS: 0DATE:
05/15/2023
TYPE OF VISIT:Case Management - OtherANNOUNCEDTIME BEGAN:
11:30 AM
MET WITH:Edgardo Rosellon, Licensee/ AdministratorTIME COMPLETED:
12:45 PM
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On 5/15/2023 at 11:30AM, Licensing Program Analyst (LPA) G. Luk conducted a face to face Component III presentation. LPA met with Licensee/Administrator, Edgardo Rosellon.

LPA presented Component III power point and discussed the regulations embodied in the presentation. LPA observed Licensee/Administrator gained knowledge about running and maintaining the facility in accordance with Title 22 regulations.

LPA concluded Component III.

Exit interview conducted with Edgardo Rosellon and a copy of this report provided.

SUPERVISORS NAME: Harpreet Humpal
LICENSING EVALUATOR NAME: Grace Luk
LICENSING EVALUATOR SIGNATURE: DATE: 05/15/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/15/2023
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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