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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 019201280
Report Date: 01/30/2024
Date Signed: 01/30/2024 12:55:14 PM

Document Has Been Signed on 01/30/2024 12:55 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:LEAP CARE SERVICES LLCFACILITY NUMBER:
019201280
ADMINISTRATOR:ECHON, RICARDOFACILITY TYPE:
740
ADDRESS:4336 EAST AVENUETELEPHONE:
(925) 223-7791
CITY:LIVERMORESTATE: CAZIP CODE:
94550
CAPACITY: 6CENSUS: 0DATE:
01/30/2024
TYPE OF VISIT:Case Management - OtherANNOUNCEDTIME BEGAN:
11:45 AM
MET WITH:Carl Arcosa, Licensee/ApplicantTIME COMPLETED:
01:10 PM
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On 1/30/2024 at 11:45AM, Licensing Program Analyst (LPA) G. Luk conducted a face to face Component III presentation. LPA met with Licensee/Applicant, Carl Arcosa.

LPA presented Component III power point and discussed the regulations embodied in the presentation. LPA observed Licensee/Applicant gained knowledge about running and maintaining the facility in accordance with Title 22 regulations.

LPA concluded Component III.

Exit interview conducted and a copy of this report provided.

SUPERVISORS NAME: Harpreet Humpal
LICENSING EVALUATOR NAME: Grace Luk
LICENSING EVALUATOR SIGNATURE: DATE: 01/30/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/30/2024
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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