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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 079201134
Report Date: 03/19/2025
Date Signed: 03/19/2025 12:04:26 PM

Document Has Been Signed on 03/19/2025 12:04 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:ANGEL CARE HOMEFACILITY NUMBER:
079201134
ADMINISTRATOR/
DIRECTOR:		WANG, DINGFACILITY TYPE:
740
ADDRESS:1723 LIMEWOOD PLACETELEPHONE:
(925) 635-3936
CITY:PITTSBURGSTATE: CAZIP CODE:
94553
CAPACITY: 6CENSUS: 5DATE:
03/19/2025
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:45 AM
MET WITH:Mary Lorraine Adriatico, CaregiverTIME VISIT/
INSPECTION COMPLETED:
12:10 PM
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On 03/19/20250:45am, Licensing Program Analyst (LPA), L. Hall conducted an unannounced case management regarding an exception request. LPA met with Mary Lorraine Adriatico, Caregiver, and explained the reason for the visit. LPA spoke with Administrator, Ding Wang, via telephone.

Upon arrival LPA observed two (2) staff, one (1) resident walking around the facility, one (1) resident eating at the kitchen table, and the other three (3) resident in their rooms. LPA reviewed R1, R2, R3, and R4's file. Scanned copies of R2 and R3 physician's report. Administrator emailed a copy of R1's physician report to LPA during visit.

No deficiencies cited during visit.

Exit interview and a copy of this report provided.
SUPERVISORS NAME: Harpreet Humpal
LICENSING EVALUATOR NAME: Laura Hall
LICENSING EVALUATOR SIGNATURE: DATE: 03/19/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/19/2025
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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