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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 075600237
Report Date: 01/30/2025
Date Signed: 01/30/2025 10:27:22 AM

Document Has Been Signed on 01/30/2025 10:27 AM - 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:OLYMPIC RETIREMENT HOMEFACILITY NUMBER:
075600237
ADMINISTRATOR/
DIRECTOR:		LIMPIN, GLENN FFACILITY TYPE:
740
ADDRESS:1862 OLYMPIC DRIVETELEPHONE:
(925) 372-8624
CITY:MARTINEZSTATE: CAZIP CODE:
94553
CAPACITY: 6TOTAL ENROLLED CHILDREN: 0CENSUS: 0DATE:
01/30/2025
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:00 AM
MET WITH:Elena Limpin, LicenseeTIME VISIT/
INSPECTION COMPLETED:
10:45 AM
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On 01/30/2025 at around 10:00 AM, Licensing Program Analysts (LPAs) L. Alexander and K. Nguyen arrived to conduct a Case Management Closure visit and met with Licensee Elena Limpin.

During the visit, LPAs inspected the facility inside and out including but not limited to bedrooms, bathrooms, kitchen, dining area, living area and garage. There were no clients observed at the facility. Licensee states that the last resident passed away in July 2024.

Licensee sent notification to Community Care Licensing Division (CCLD) on December 20, 2024 regarding ceasing operation. LPA, L. Alexander, received closure notification from Licensee via phone call stating that facility is no longer interested in operating effective August 01, 2024. Original facility license was surrendered to LPAs during the visit.
Bennett FongTELEPHONE: (510) 725-7919
Lori Alexander-WashingtonTELEPHONE: (510) 285-3934
DATE: 01/30/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/30/2025
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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