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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 02:48:55 PM

Document Has Been Signed on 01/17/2025 02:48 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:Case Management - OtherUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:50 PM
MET WITH:Tilisa Lolohea, Licensee/AdministratorTIME VISIT/
INSPECTION COMPLETED:
03:00 PM
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On 1/17/2025 at 1:50pm, Licensing Program Analyst (LPA), L. Hall arrived to conduct an announced case management. LPA met with Tilisa Lolohea, 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: 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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