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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 019201472
Report Date: 01/29/2025
Date Signed: 01/29/2025 01:17:57 PM

Document Has Been Signed on 01/29/2025 01:17 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
OAKLAND ASC, 1515 CLAY STREET, STE. 310
OAKLAND, CA 94612
FACILITY NAME:OUR THREE HEARTS CARE HOME LLCFACILITY NUMBER:
019201472
ADMINISTRATOR/
DIRECTOR:		LABRADOR, EDWARDFACILITY TYPE:
740
ADDRESS:35459 CLEREMONT DRIVETELEPHONE:
(341) 249-4800
CITY:NEWARKSTATE: CAZIP CODE:
94560
CAPACITY: 6CENSUS: 0DATE:
01/29/2025
TYPE OF VISIT:Case Management - OtherANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
11:40 AM
MET WITH:Edward Labrador, Administrator TIME VISIT/
INSPECTION COMPLETED:
01:30 PM
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On 01/29/2025 at 11:40 AM, Licensing Program Analysts (LPAs) P. Manalo and L. Fontanilla arrived announced to conduct Component lll with Licensee/applicant Edward Labrador.

LPAs went over with Licensee/ applicant Component lll Power point presentation. LPAs provided applicant with CCLD and LPA contact information.

A copy of this report was provided to applicant.
SUPERVISORS NAME: Yvonne Flores-Larios
LICENSING EVALUATOR NAME: Patricia Manalo
LICENSING EVALUATOR SIGNATURE: DATE: 01/29/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/29/2025
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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