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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 079201419
Report Date: 12/30/2024
Date Signed: 12/30/2024 02:02:58 PM

Document Has Been Signed on 12/30/2024 02:02 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
E BAY DELTA AC/SC, 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: 6DATE:
12/30/2024
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
12:40 PM
MET WITH:Alexandru Tet, AdministratorTIME VISIT/
INSPECTION COMPLETED:
02:15 PM
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On 12/30/2024 at 12:40 PM, Licensing Program Analyst (LPA) L. Alexander arrived unannounced to conduct a Pre-Licensing inspection. LPA met with Administrators, Alexandru "Alex" and EcaterinaTet and explained the purpose of the visit. The facility currently has six (6) residents. Licensee/Administrator, Samuel Tet, arrived shortly.

LPA toured facility with Alex and Ecaterina including but not limited to six (6) bedrooms, three (3) bathrooms, kitchen, garage, common areas and backyard. Bedrooms and living rooms were equipped with the proper furniture. Bathrooms were equipped with grab bars and non-skid mats. Linens and hygiene supplies were observed inside a cabinet. There is sufficient lighting throughout facility. Room temperature was maintained at 73 degrees F and hot water temperature was measured at 114.0 degrees F. First-aid kit was observed to be complete. Smoke detectors and carbon monoxide were operational. Fire extinguisher was purchased on 04/23/2024.

No issues noted during inspection. LPA observed that facility is ready to be licensed. This report will be submitted to the Central Applications Bureau (CAB) and a final review of the application will be conducted. This facility is not yet licensed and is subject to final approval by CAB. Additional requirements may still be required.

Exit interview conducted and a copy of this report provided.
SUPERVISORS NAME: Bennett Fong
LICENSING EVALUATOR NAME: Lori Alexander-Washington
LICENSING EVALUATOR SIGNATURE: DATE: 12/30/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/30/2024
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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