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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 079200991
Report Date: 03/30/2022
Date Signed: 03/30/2022 02:36:42 PM

Document Has Been Signed on 03/30/2022 02:36 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:AGNES HOUSEFACILITY NUMBER:
079200991
ADMINISTRATOR:BERNARDINO, ALBERTOFACILITY TYPE:
740
ADDRESS:1644 BECKNER CTTELEPHONE:
(925) 338-2399
CITY:CONCORDSTATE: CAZIP CODE:
94521
CAPACITY: 6CENSUS: 0DATE:
03/30/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Alberto BernardinoTIME COMPLETED:
12:30 PM
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On 03/30/2022 at 10:00AM, Licensing Program Analyst (LPA) J. Sampair conducted a Case Management visit with Administrator (ADM) Alberto Bernardino. LPA explained that the purpose of the visit was to check on a report that the facility had been closed, though the Department had not received a closure notice from them.

The ADM explained that they had no residents currently and that they had not ever had any residents at this facility. He had planned to transfer this license to the new facility, also named AGNES HOUSE (License #079201047) on 1660 ARKELL RD in WALNUT CREEK. However, after that facility was licensed in April of 2021, he decided not to close this facility. Administrator stated they wanted to keep the license and has continued to pay the annual fees. His family is currently living in the facility.

Exit interview was conducted with ADM and he was given a copy of this report.
SUPERVISORS NAME: Harpreet Humpal
LICENSING EVALUATOR NAME: James Sampair
LICENSING EVALUATOR SIGNATURE: DATE: 03/30/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/30/2022
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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