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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 079201257
Report Date: 08/13/2024
Date Signed: 08/13/2024 03:24:35 PM

Document Has Been Signed on 08/13/2024 03:24 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:GOOD SHEPHERD OF DANVILLEFACILITY NUMBER:
079201257
ADMINISTRATOR/
DIRECTOR:		CASTRO, ROCHEFACILITY TYPE:
740
ADDRESS:287 VERDE MESATELEPHONE:
(925) 719-9351
CITY:DANVILLESTATE: CAZIP CODE:
94526
CAPACITY: 6CENSUS: 6DATE:
08/13/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
03:14 PM
MET WITH:Caregiver, Rommel DimzonTIME VISIT/
INSPECTION COMPLETED:
03:45 PM
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On 8/13/2024 at 3:14 PM Licensing Program analyst (LPA) A. Gomez arrived unannounced to conduct a case management visit relating to the complaint investigation done on 8/8/2024. LPA met with Caregiver, Rommel Dimzon and explained the purpose of the visit.

On 8/1/2024 LPA came to the facility to conduct an initial 10-day complaint investigation and deliver findings. LPA met with Administrator, Maria Arceo. At the time of the visit LPA did not put who they met with on the top of the report. LPA amended the incorrect report and provided the facility with a copy of the amended report.

No deficiencies cited during visit. Exit interview conducted and a copy of this report provided.

SUPERVISORS NAME: Yvonne Flores-Larios
LICENSING EVALUATOR NAME: Alona Gomez
LICENSING EVALUATOR SIGNATURE: DATE: 08/13/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/13/2024
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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