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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 019201168
Report Date: 08/09/2022
Date Signed: 08/09/2022 05:22:23 PM

Document Has Been Signed on 08/09/2022 05:22 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:GENUINE LOVE CARE HOMEFACILITY NUMBER:
019201168
ADMINISTRATOR:DIMAGUILA, HAROLDFACILITY TYPE:
740
ADDRESS:22947 FULLER AVE.TELEPHONE:
(510) 274-5207
CITY:HAYWARDSTATE: CAZIP CODE:
94541
CAPACITY: 6CENSUS: 0DATE:
08/09/2022
TYPE OF VISIT:Case Management - OtherANNOUNCEDTIME BEGAN:
03:15 PM
MET WITH:Applicants Emelita Dimaguila
and Harold Dimaguila 		TIME COMPLETED:
05:25 PM
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Licensing Program Analyst (LPA) Delmundo conducted an announced Component III Training via Teams Meeting. Component III was attended by Emelita Dimaguila and Harold Dimaguila, license applicants.

LPA presented the training via Power Point presentation and had a discussion with Emelita and Harold.

Exit interview conducted and copy of this report provided at the conclusion of the training.
SUPERVISORS NAME: Bennett Fong
LICENSING EVALUATOR NAME: Alicia Delmundo
LICENSING EVALUATOR SIGNATURE: DATE: 08/09/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/09/2022
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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