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Department of
SOCIAL SERVICES
Community Care Licensing
FACILITY EVALUATION REPORT
Facility Number:
079201391
Report Date:
10/08/2024
Date Signed:
10/08/2024 12:49:25 PM
Document Has Been Signed on
10/08/2024 12:49 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:
ANCHOR ELDERLY CARE HOME
FACILITY NUMBER:
079201391
ADMINISTRATOR/
DIRECTOR:
MORALES-ALTOBAR, MAE
FACILITY TYPE:
740
ADDRESS:
2268 HIGHLANDS ROAD
TELEPHONE:
(510) 724-3248
CITY:
SAN PABLO
STATE:
CA
ZIP CODE:
94806
CAPACITY:
5
CENSUS:
4
DATE:
10/08/2024
TYPE OF VISIT:
Case Management - Other
UNANNOUNCED
TIME VISIT/
INSPECTION BEGAN:
01:17 PM
MET WITH:
Mae Morales-Altobar Administrator
TIME VISIT/
INSPECTION COMPLETED:
01:45 PM
NARRATIVE
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An announced Pre-licensing Comp III associated with Pre-Licensing Inspection done on `0/08/2024 at 12:00 PM was conducted by Licensing Program Analysts (LPAs) Carol Fowler and David Doidge. Comp III was attended by Mae Morales-Altobar Administrator.
LPAs discussed the power point after which LPAs observed Licensee Mae Morales-Altobar with a better and clear understanding of Title 22 regulations and Community Care Licensing in general.
LPAs concluded Comp III.
No citation made during this visit. Exit interview conducted and a copy of this report provided.
SUPERVISORS NAME
:
Bennett Fong
LICENSING EVALUATOR NAME
:
Carol Fowler
LICENSING EVALUATOR SIGNATURE
:
DATE:
10/08/2024
I acknowledge receipt of this form and understand my
licensing
appeal rights as
explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE:
10/08/2024
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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