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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 079201270
Report Date: 10/05/2023
Date Signed: 10/05/2023 02:34:27 PM

Document Has Been Signed on 10/05/2023 02:34 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:TOYON CARE IIFACILITY NUMBER:
079201270
ADMINISTRATOR:WEI, ANGELAFACILITY TYPE:
740
ADDRESS:2365 WRIGHT AVETELEPHONE:
(415) 606-6829
CITY:PINOLESTATE: CAZIP CODE:
94564
CAPACITY: 6CENSUS: 0DATE:
10/05/2023
TYPE OF VISIT:Case Management - OtherANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH:Angela Wei, Licensee/AdministratorTIME COMPLETED:
02:50 PM
NARRATIVE
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On 10/5/2023 at 1:00PM, Licensing Program Analyst (LPA) G. Luk conducted a face to face Component III presentation. LPA met with Licensee/Administrator, Angela Wei.

LPA presented Component III power point and discussed the regulations embodied in the presentation. LPA observed Licensee/Administrator gained knowledge about running and maintaining the facility in accordance with Title 22 regulations.

LPA concluded Component III.

Exit interview conducted with Angela Wei and a copy of this report provided.

SUPERVISORS NAME: Harpreet Humpal
LICENSING EVALUATOR NAME: Grace Luk
LICENSING EVALUATOR SIGNATURE: DATE: 10/05/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/05/2023
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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