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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 079200331
Report Date: 09/04/2024
Date Signed: 09/17/2024 12:18:16 PM


Document Has Been Signed on 09/17/2024 12:18 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:DREAN OF ANGEL CARE LLCFACILITY NUMBER:
079200331
ADMINISTRATOR:ANGIE ESPLANAFACILITY TYPE:
740
ADDRESS:274 STARLING WAYTELEPHONE:
(510) 313-0361
CITY:HERCULESSTATE: CAZIP CODE:
94547
CAPACITY:6CENSUS: 0DATE:
09/04/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
04:05 PM
MET WITH:TIME COMPLETED:
04:30 PM
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On 09/04/2024 at 4:05pm, Licensing Program Analysts (LPAs) Carol Fowler arrived unannounced to conduct an annual 1-year required inspection.

Upon arrival there was no answer at the door, the front yard was un-kept and the blinds were closed. However on 4/27/2023 LPA Carol Fowler arrived at the facility to conduct an annual 1-year required inspection, and LPA was informed by House Manager Jean Felix that the facility would be ceasing operation on 4/30/2023. On 4/27/2023 LPA spoke with R1's Case Manager that confirmed R1 would be relocated into a new facility on 4/30/2023. House Manager Jean Felix, stated that she would call LPA once the resident has been transferred to the new facility. LPA Carol Fowler also attempted to speak with the Licensee and there was no answer, LPA left a voice mail. LPA Carol Fowler never received a call from the House Manager or Licensee. LPA Carol Fowler called the facility 5 consecutive day starting on 3/25/2024, 3/26/2024, 3/27/2024, 3/28/2024 and 3/29/2024 the phone number has been disconnected.
SUPERVISOR'S NAME: Bennett FongTELEPHONE: (510) -62-2621
LICENSING EVALUATOR NAME: Carol FowlerTELEPHONE: (510) 622-2715
LICENSING EVALUATOR SIGNATURE:
DATE: 09/06/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/06/2024
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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