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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 079201155
Report Date: 10/13/2022
Date Signed: 10/13/2022 12:00:21 PM

Document Has Been Signed on 10/13/2022 12:00 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:TAREYTON HOME, LLCFACILITY NUMBER:
079201155
ADMINISTRATOR:FARIN DE DIOS, MIGUELAFACILITY TYPE:
740
ADDRESS:9675 TAREYTON AVE.TELEPHONE:
(925) 588-1886
CITY:SAN RAMONSTATE: CAZIP CODE:
94583
CAPACITY: 6CENSUS: 6DATE:
10/13/2022
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
10:15 AM
MET WITH:Miguela Farin De Dios, AdministratorTIME COMPLETED:
12:15 PM
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On 10/13/2022 starting at 10:30 AM, Licensing Program Analysts (LPAs) L. Francisco and K. Nguyen arrived unannounced to conduct a Prelicensing Inspection due change of ownership. LPA met with Administrator, Miguela Farin De Dios and explained the purpose of the visit. The facility currently has existing clients. The fire clearance is approved for all may be non-ambulatory.

LPAs toured facility with Administrator including but not limited to 4 client bedrooms, 2 staff bedrooms, 2 bathrooms, kitchen, common areas and backyard. Bedrooms and living rooms were equipped with the proper furniture. Bathrooms were equipped with grab bars and non-skid mats. Linens and hygiene supplies were observed stored in the hallway closet. There is sufficient lighting throughout facility. Central medication storage is locked. Room temperature is maintained at 71 degrees F and hot water temperature is maintained at 105 degrees F. First-aid kit was observed to be complete. There is no bodies of water observed. Smoke detectors and carbon monoxide were operational during visit. Fire extinguisher was last serviced on 9/13/2022.

No issues noted during inspection. LPAs observed that facility is ready to be licensed. This report will be submitted to the Central Applications Unit (CAU) and a final review of the application will be conducted. This facility is not yet licensed, and is subject to final approval by CAU. Additional requirements may still be required.

COMP III is being waived because Administrator is an existing Administrator and for previous licensed facility.

Exit interview conducted and a copy of this report provided.
SUPERVISORS NAME: Harpreet Humpal
LICENSING EVALUATOR NAME: Lizette Francisco
LICENSING EVALUATOR SIGNATURE: DATE: 10/13/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/13/2022
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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