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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 079201363
Report Date: 10/11/2024
Date Signed: 10/11/2024 10:09:55 AM

Document Has Been Signed on 10/11/2024 10:09 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:ADAURE HOME CAREFACILITY NUMBER:
079201363
ADMINISTRATOR/
DIRECTOR:		ESOMONU, JUSTINEFACILITY TYPE:
735
ADDRESS:1073 METTEN AVETELEPHONE:
(925) 214-8468
CITY:PITTSBURGSTATE: CAZIP CODE:
94565
CAPACITY: 6CENSUS: 5DATE:
10/11/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:10 AM
MET WITH:Justine Esomonu, AdministratorTIME VISIT/
INSPECTION COMPLETED:
10:15 AM
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On 10/11/2024 at 9:10am, Licensing Program Analyst (LPA) L. Hall conducted an unannounced Case Management visit regarding an incident that was reported to CCLD on 10/1/2024. LPA met with Justine Esomonu, Administrator that arrived at 9:30 and explained the purpose of the visit.

The incident occurred on 9/25/2024 where C1 AWOL'd. C1 was placed on respite services on 9/23/2024, and admitted to the facility on 10/7/2024. S1 stated C1 has an appointment to obtain the physician's report. S1 also stated C1 is able to leave the facility unassisted.

No deficiencies issued during the visit.

Exit interview conducted and a copy of this report was provided.
SUPERVISORS NAME: Harpreet Humpal
LICENSING EVALUATOR NAME: Laura Hall
LICENSING EVALUATOR SIGNATURE: DATE: 10/11/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/11/2024
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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