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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 079201419
Report Date: 09/12/2024
Date Signed: 09/16/2024 04:40:41 PM

Document Has Been Signed on 09/16/2024 04:40 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
OAKLAND ASC, 1515 CLAY STREET, STE. 310
OAKLAND, CA 94612
FACILITY NAME:CORAL ASSISTED LIVINGFACILITY NUMBER:
079201419
ADMINISTRATOR/
DIRECTOR:		TET, SAMUELFACILITY TYPE:
740
ADDRESS:5126 CORAL COURTTELEPHONE:
(510) 689-2286
CITY:CONCORDSTATE: CAZIP CODE:
94521
CAPACITY: 6CENSUS: 0DATE:
09/12/2024
TYPE OF VISIT:PrelicensingANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
11:16 AM
MET WITH:TIME VISIT/
INSPECTION COMPLETED:
01:50 PM
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This report is being amended due to LPA T. Syess-Gibson generating a Pre-licensing Report under wrong facility number. LPA did generate a correct report under the correct facility number. LPA has been given authorization from LPM H. Humpal to amend the report.

*****This is an Amended Report*****

SUPERVISORS NAME: Harpreet Humpal
LICENSING EVALUATOR NAME: Tonica Syess-Gibson
LICENSING EVALUATOR SIGNATURE: DATE: 09/12/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/12/2024
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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