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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 079201267
Report Date: 09/07/2023
Date Signed: 09/07/2023 11:46:05 AM

Document Has Been Signed on 09/07/2023 11:46 AM - 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:CAMKRIS TOTAL CARE HOMEFACILITY NUMBER:
079201267
ADMINISTRATOR:TABONES, FELOMENAFACILITY TYPE:
740
ADDRESS:5017 SAINT GARRETT COURTTELEPHONE:
(925) 664-1941
CITY:CONCORDSTATE: CAZIP CODE:
94521
CAPACITY: 6CENSUS: 0DATE:
09/07/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
10:35 AM
MET WITH:Felomena Tabones, AdministratorTIME COMPLETED:
11:45 AM
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On 09/07/2023 at 10:35 AM, Licensing Program Analyst (LPA) P. Watson conducted a face to face Component III presentation with Administrator, Felomena Tabones.


LPA presented Component III power point and discussed the regulations embodied in the power point. LPA observed participant 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: 09/07/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/07/2023
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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