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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 079201452
Report Date: 12/11/2024
Date Signed: 12/11/2024 12:28:31 PM

Document Has Been Signed on 12/11/2024 12:28 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:CATHEDRAL CARE HOME - OAKLEYFACILITY NUMBER:
079201452
ADMINISTRATOR/
DIRECTOR:		DATUIN, MARIVICFACILITY TYPE:
740
ADDRESS:1916 CINNAMON RIDGE DRIVETELEPHONE:
(925) 626-7175
CITY:OAKLEYSTATE: CAZIP CODE:
94561
CAPACITY: 6CENSUS: 0DATE:
12/11/2024
TYPE OF VISIT:Case Management - OtherANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
12:15 PM
MET WITH:Marivic Datuin, AdministratorTIME VISIT/
INSPECTION COMPLETED:
12:35 PM
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On 12/11/2024 at 10:20AM Licensing Program Analyst (LPA) T. Syess-Gibson conducted an announced pre-licensing inspection with a Comp III and met with Marivic Datuin, Administrator.

Comp III was waived per Licensing Program Manager (LPM) Y. Flores-Larios.

Exit interview conducted and a copy of this report provided.
SUPERVISORS NAME: Harpreet Humpal
LICENSING EVALUATOR NAME: Tonica Syess-Gibson
LICENSING EVALUATOR SIGNATURE: DATE: 12/11/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/11/2024
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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