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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 079201227
Report Date: 03/16/2023
Date Signed: 03/16/2023 12:00:02 PM

Document Has Been Signed on 03/16/2023 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
E BAY DELTA AC/SC, 1515 CLAY STREET, STE. 310
OAKLAND, CA 94612
FACILITY NAME:CARE 4 ONE IIFACILITY NUMBER:
079201227
ADMINISTRATOR:ELGADO, LIZA JAYFACILITY TYPE:
740
ADDRESS:3910 BAYVIEW CIRTELEPHONE:
(925) 464-3891
CITY:CONCORDSTATE: CAZIP CODE:
94520
CAPACITY: 6CENSUS: 0DATE:
03/16/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
11:30 AM
MET WITH:Liza Jay Elgado, AdministratorTIME COMPLETED:
12:00 PM
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On 03/16/2023 at 11:30 AM, Licensing Program Analyst (LPA) P. Watson conducted a face to face Component III presentation. LPA conducted Component III with Administrator, Liza Jay Elgado.

LPA presented Component III power point and discussed the regulations embodied in the power point. LPAs observed participants gained knowledge about running and maintaining the facility in accordance with regulations.

Exit interview conducted and a copy of report provided.
SUPERVISORS NAME: Yvonne Flores-Larios
LICENSING EVALUATOR NAME: Paris Watson
LICENSING EVALUATOR SIGNATURE: DATE: 03/16/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/16/2023
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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