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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 079201377
Report Date: 05/23/2024
Date Signed: 05/23/2024 03:16:14 PM

Document Has Been Signed on 05/23/2024 03:16 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:VISTA HOMEFACILITY NUMBER:
079201377
ADMINISTRATOR/
DIRECTOR:		PHAM, FENINAFACILITY TYPE:
735
ADDRESS:4282 GOLDENHILL DRIVETELEPHONE:
(925) 997-8087
CITY:PITTSBURGSTATE: CAZIP CODE:
94565
CAPACITY: 4CENSUS: 0DATE:
05/23/2024
TYPE OF VISIT:Case Management - OtherANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
02:40 PM
MET WITH:Fenina Pham, Licensee/AdministratorTIME VISIT/
INSPECTION COMPLETED:
03:25 PM
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On 5/23/2024 at 2:40pm, Licensing Program Analyst (LPA), L. Hall arrived to conduct an announced case management visit. LPA met with Fenina Pham, LIcensee/Administrator, and explained the purpose of the visit.

LPA presented Component III power point during visit and discussed the regulations embodied in the power point. LPA observed the participant gained knowledge about running and maintaining the facility in accordance with regulations.

A license has not yet been granted to this facility. Licensure is subject to final review and approval by the Centralized Applications Unit. Licensee is not to accept consumers until notified by Community Care Licensing that the license has been approved.

No deficiencies cited during visit.

Exit interview conducted and a copy of this report provided.
SUPERVISORS NAME: Harpreet Humpal
LICENSING EVALUATOR NAME: Laura Hall
LICENSING EVALUATOR SIGNATURE: DATE: 05/23/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/23/2024
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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