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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 079201365
Report Date: 06/18/2024
Date Signed: 06/18/2024 12:13:59 PM

Document Has Been Signed on 06/18/2024 12:13 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:HOPE & HAPPINESS PLACE, INCFACILITY NUMBER:
079201365
ADMINISTRATOR/
DIRECTOR:		GIL, MARIA ANTONIAFACILITY TYPE:
740
ADDRESS:3926 SPRIG WAYTELEPHONE:
(407) 808-4153
CITY:ANTIOCHSTATE: CAZIP CODE:
94509
CAPACITY: 6CENSUS: 0DATE:
06/18/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
11:30 AM
MET WITH:Fernando Queija Garcia, House ManagerTIME VISIT/
INSPECTION COMPLETED:
12:30 PM
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LPA Greg Clark conducted a face to face Component III presentation on 6/18/24. LPA met with Fernando Queija Garcia, House Manager. LPA spoke with Administrator Marie Gil who gave permission for House Manager to complete COMP III. Marie Gil is currently the Administrator of an RCFE (J&M Residential Care II) in Antioch.

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

Exit interview conducted and a copy provided.
SUPERVISORS NAME: Yvonne Flores-Larios
LICENSING EVALUATOR NAME: Gregory Clark
LICENSING EVALUATOR SIGNATURE: DATE: 06/18/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/18/2024
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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