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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 075601201
Report Date: 09/29/2023
Date Signed: 09/29/2023 04:39:39 PM


Document Has Been Signed on 09/29/2023 04:39 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:AMAZING HOME CAREFACILITY NUMBER:
075601201
ADMINISTRATOR:MANALANG, ADELAIDA DFACILITY TYPE:
740
ADDRESS:2245 SANTA MARIA DRIVETELEPHONE:
(925) 261-0380
CITY:PITTSBURGSTATE: CAZIP CODE:
94565
CAPACITY:6CENSUS: 1DATE:
09/29/2023
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
04:15 PM
MET WITH:Marilou Solomon, LicenseeTIME COMPLETED:
04:45 PM
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On 9/29/2023 at 4:15pm, Licensing Program Analyst (LPA) L. Hall arrived unannounced to conduct proof of correction (POC) visit. LPA met with Marilou Solomon, Licensee, and explained the purpose of the visit.

LPA conducted a case management visit on 9/14/2023 and cited facility for the following:

  • 87405(a) Administrator - Qualifications and Duties - LPA was informed that S2 will take classed in November 2023 to become the administrator. Facility will not take any resident until an administrator is hired.

Exit interview conducted and a copy of this report provided.
SUPERVISOR'S NAME: Harpreet HumpalTELEPHONE: (510) 285-3928
LICENSING EVALUATOR NAME: Laura HallTELEPHONE: (510) 622-2024
LICENSING EVALUATOR SIGNATURE:
DATE: 09/29/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/29/2023
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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