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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 015600693
Report Date: 01/29/2024
Date Signed: 01/29/2024 04:02:55 PM


Document Has Been Signed on 01/29/2024 04:02 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:PLEASANT HILL MANORFACILITY NUMBER:
015600693
ADMINISTRATOR:RICHARD W. GINDLESBERGERFACILITY TYPE:
740
ADDRESS:27794 PLEASANT HILL CTTELEPHONE:
(510) 581-3557
CITY:HAYWARDSTATE: CAZIP CODE:
94542
CAPACITY:6CENSUS: 5DATE:
01/29/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH:RICHARD W. GINDLESBERGER- AdministratorTIME COMPLETED:
04:25 PM
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On 1/29/2024 at 1:00PM, Licensing Program Analyst (LPA) K. Nguyen arrived unannounced to conduct 1-Year Annual Required inspection. LPA met with Administrator, RICHARD W. GINDLESBERGER and explained the purpose of the visit.

The required annual inspection is incomplete and LPA will return to complete inspection at a later date.

No deficiencies cited during visit. Exit interview conducted and a copy of this report provided via email.
SUPERVISOR'S NAME: Bennett FongTELEPHONE: (510) 725-7919
LICENSING EVALUATOR NAME: Kelly NguyenTELEPHONE: (510) 915-8702
LICENSING EVALUATOR SIGNATURE:
DATE: 01/29/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/29/2024
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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