<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 011441151
Report Date: 06/12/2024
Date Signed: 06/12/2024 03:03:11 PM

Document Has Been Signed on 06/12/2024 03:03 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
E BAY DELTA AC/SC, 1515 CLAY STREET, STE. 310
OAKLAND, CA 94612
FACILITY NAME:ANGELEON CARE HOMEFACILITY NUMBER:
011441151
ADMINISTRATOR/
DIRECTOR:		DE LEON, RICHARDFACILITY TYPE:
740
ADDRESS:2124 ASHBY AVENUETELEPHONE:
(510) 704-8319
CITY:BERKELEYSTATE: CAZIP CODE:
94705
CAPACITY: 12CENSUS: 11DATE:
06/12/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:45 PM
MET WITH:Danilo Villar, CaregiverTIME VISIT/
INSPECTION COMPLETED:
03:20 PM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
On 06/12/2024 at 1:45PM Licensing Program Analysts (LPAs) L. Alexander and L. Holmes arrived unannounced to conduct a Case Management regarding continuing the Pre-Licensing process with Licensee/Administrator, Richard De Leon. LPAs met with Caregiver, Danilo Villar, and explained the purpose of the visit. LPAs phoned Mr. De Leon and spoke with him regarding the COMP III that still needs to be completed. Mr. De Leon stated that he would not be available to come to the facility for the visit. LPAs advised Mr. De Leon that the Pre-Licensing will not be approved until the COMP III can be conducted and completed in-person. Mr. De Leon stated that he understood the requirements.

LPAs also reminded Mr. De Leon that the Technical Assistance (TA) - Advisory Notes included Title 22 Regulations: 87468(c), 87468(c)(1) and 87468(c)(2)(A). LPAs observed that the posted documents still were not posted in the facility. Mr. De Leon requested if LPAs could resend him the TAs for his review and that he will have the documents posted.

No deficiencies cited during visit. Exit interview conducted and a copy of this report provided.
SUPERVISORS NAME: Bennett Fong
LICENSING EVALUATOR NAME: Lori Alexander-Washington
LICENSING EVALUATOR SIGNATURE: DATE: 06/12/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/12/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 1