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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 075601399
Report Date: 07/05/2023
Date Signed: 07/05/2023 09:32:58 AM


COMPREHENSIVE INSPECTION

Document Has Been Signed on 07/05/2023 09:32 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
CCLD Regional Office, 1515 CLAY STREET, STE. 310
OAKLAND, CA 94612



FACILITY NAME:ABIGAIL BOARD AND CAREFACILITY NUMBER:
075601399
ADMINISTRATOR:IRVAN, TAMSIEFACILITY TYPE:
740
ADDRESS:4369 ROSE LANETELEPHONE:
(925) 825-3594
CITY:CONCORDSTATE: CAZIP CODE:
94518
CAPACITY:6CENSUS: 0DATE:
07/05/2023
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
09:15 AM
MET WITH:Jeri Brant, Facility representitive TIME COMPLETED:
09:45 AM
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Licensing Program Analyst (LPA) J Clancy-Czuleger arrived to the facility announced to confirm that the facility is closed and is no longer in operation. On 06/21/2023 LPA received notification that the facility will be closing.

Upon arrival at the facility LPA was met by Jeri Brant, who was sent by the licensee Tamsie Irvan to do the final walk through as Tamsie was not able to make it. The LPA walked around the facility inside and out and confirmed there was no residents at the facility. LPA collected the original copy of the License at this time.

Exit interview conducted and a copy of this report provided.
SUPERVISOR'S NAME: Harpreet HumpalTELEPHONE: (510) 285-3928
LICENSING EVALUATOR NAME: Jill Clancy-CzulegerTELEPHONE: 510-286-4201
LICENSING EVALUATOR SIGNATURE:
DATE: 07/05/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/05/2023
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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