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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 019201003
Report Date: 11/27/2024
Date Signed: 11/27/2024 01:13:16 PM

Document Has Been Signed on 11/27/2024 01:13 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:MILAN VILLA SENIOR LIVINGFACILITY NUMBER:
019201003
ADMINISTRATOR/
DIRECTOR:		GOMBIO, JANICEFACILITY TYPE:
740
ADDRESS:740 HOLMES STREETTELEPHONE:
(925) 583-5777
CITY:LIVERMORESTATE: CAZIP CODE:
94550
CAPACITY: 24CENSUS: 18DATE:
11/27/2024
TYPE OF VISIT:Case Management - Health ChecksUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:20 AM
MET WITH:Isabel Poderoso, Campus DirectorTIME VISIT/
INSPECTION COMPLETED:
10:55 AM
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On 11/27/2024 at 10:20am, Licensing Program Analysts (LPAs), L. Hall and D. Doidge arrived unannounced to conduct a health and safety check as a result of the department receiving a complaint on 11/26/2024. LPA met with Isabel Poderoso, Campus Director, and explained the reason for the visit. Administrator, Janice Gambio, arrived at 10:53am.

During the health and safety check, LPAs toured the facility including but not limited to common areas, kitchen, bathrooms, bedrooms and outdoor area. LPAs observed resident sitting in common area watching television, in bedrooms, and hallway. The facility is noted to be clean, in good repair, and residents in care appear to be safe. There is a minimum of 7-day non-perishables and 2-day perishables foods that is kept in the sister facility next door. There are no imminent health/safety concerns on today's date.

No deficiencies were cited today.

Exit interview conducted and a copy of this report provided.
SUPERVISORS NAME: Harpreet Humpal
LICENSING EVALUATOR NAME: Laura Hall
LICENSING EVALUATOR SIGNATURE: DATE: 11/27/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/27/2024
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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