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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 075601519
Report Date: 09/19/2023
Date Signed: 09/19/2023 05:08:10 PM

Document Has Been Signed on 09/19/2023 05:08 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:LAFAYETTE HEIGHTS RESIDENTIAL CARE IIFACILITY NUMBER:
075601519
ADMINISTRATOR:MOGADAM, JOANNEFACILITY TYPE:
740
ADDRESS:2267 SHANNON LANETELEPHONE:
(925) 979-1200
CITY:WALNUT CREEKSTATE: CAZIP CODE:
94598
CAPACITY: 6CENSUS: 0DATE:
09/19/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Boyet AzoresTIME COMPLETED:
10:30 AM
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On 9/19/2023 at 8:30 AM, Licensing Program Analyst (LPA) J. Sampair conducted an unannounced annual inspection. Upon arrival, the LPA explained purpose of the visit to Boyet Azores. Mr. Azores stated that there are no residents at the facility. LPA then spoke with Licensee Joanne Mogadam over the phone.

No citations issued.

Exit interview conducted and a copy of this report provided via email
SUPERVISORS NAME: Bennett Fong
LICENSING EVALUATOR NAME: James Sampair
LICENSING EVALUATOR SIGNATURE: DATE: 09/19/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/19/2023
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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