<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 079200577
Report Date: 12/03/2024
Date Signed: 12/03/2024 04:29:19 PM

Document Has Been Signed on 12/03/2024 04:29 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:SANTA TERESA CARE HOMEFACILITY NUMBER:
079200577
ADMINISTRATOR/
DIRECTOR:		CALAMBRO, MARIVEL NFACILITY TYPE:
740
ADDRESS:10 SANTA TERESA CTTELEPHONE:
(925) 261-9397
CITY:PITTSBURGSTATE: CAZIP CODE:
94565
CAPACITY: 6CENSUS: 5DATE:
12/03/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
03:10 PM
MET WITH:Elaine Francisco, CaregiverTIME VISIT/
INSPECTION COMPLETED:
04:35 PM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
On 12/3/2024 at 3:10pm, Licensing Program Analyst (LPA) L. Hall arrived unannounced to conduct a Case Management visit. LPA met with Elaine Francisco, Caregiver. Administrator, Marivel Calambro, arrived at 3:35pm, and LPA explained the reason for the visit.

On 11/20/2024, LPA received an unapproved fire clearance for facility. S1 stated that she did not receive call from inspector for this facility. LPA spoke with fire inspector during visit. S1 will speak with responsible party's to move residents to different rooms or submit updated LIC200 to CCLD to resubmit to Contra Costa County fire by 12/10/2024. LPA reviewed all five (5) residents physician's report during visit.

Exit interview conducted. A copy of this report and appeal rights provided
SUPERVISORS NAME: Harpreet Humpal
LICENSING EVALUATOR NAME: Laura Hall
LICENSING EVALUATOR SIGNATURE: DATE: 12/03/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/03/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 1