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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 079201438
Report Date: 01/17/2025
Date Signed: 01/17/2025 02:47:50 PM

Document Has Been Signed on 01/17/2025 02:47 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:A SERENITY CARE HOMEFACILITY NUMBER:
079201438
ADMINISTRATOR/
DIRECTOR:
LOLOHEA, TILISAFACILITY TYPE:
740
ADDRESS:1971 NEWPORT DRIVETELEPHONE:
(510) 255-0473
CITY:PITTSBURGSTATE: CAZIP CODE:
94565
CAPACITY: 4CENSUS: 0DATE:
01/17/2025
TYPE OF VISIT:PrelicensingANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
12:45 PM
MET WITH:Tilisa Lolohea, Licensee/AdministratorTIME VISIT/
INSPECTION COMPLETED:
01:45 PM
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On 1/16/2025 at 12:45pm, Licensing Program Analyst (LPA) L. Hall conducted an announced pre-licensing inspection and met with Tilisa Lolohea, Licensee/Administrator.

LPA toured the client’s bedrooms, bathrooms, dining rooms, common living areas, kitchen, and backyard. There is sufficient lighting around the facility. Resident rooms are equipped with the proper furniture and lighting. Residents rooms have proper bedding and linens for the residents to use. The kitchen was observed cleaned and within compliance. Bathrooms were equipped with grab bars and hygiene items. Living room is equipped with the proper furniture for the residents. Facility has locked drawer for sharps and locked closet for medication. Passageways and hallways are free of obstruction. Fire extinguisher is in compliance. Smoke detectors and Carbon Monoxide detector are equipped around the facility. First aid kit is complete. Hot water temperature is measured at 110.9 degrees Fahrenheit. This is an existing facility and 2-day perishable, and 7-day non-perishable are available for the residents. LPA observed van to be in good repair and working condition. Facility inspection matches the sketch that was provided.

No issues noted during inspection. LPAs observed that facility is ready to be licensed. This report will be submitted to the Central Applications Unit (CAU) and a final review of the application will be conducted. This facility is not yet licensed and is subject to final approval by CAU. Additional requirements may still be required.

Exit interview conducted and a copy of this report provided.
SUPERVISORS NAME: Harpreet Humpal
LICENSING EVALUATOR NAME: Laura Hall
LICENSING EVALUATOR SIGNATURE: DATE: 01/17/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/17/2025
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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