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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 079201426
Report Date: 12/03/2024
Date Signed: 12/03/2024 12:50:53 PM

Document Has Been Signed on 12/03/2024 12:50 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:A DIABLO ASSISTED LIVING 1FACILITY NUMBER:
079201426
ADMINISTRATOR/
DIRECTOR:		EVANGELISTA, MARICELFACILITY TYPE:
740
ADDRESS:123 LOS CERROS AVETELEPHONE:
(925) 289-6588
CITY:WALNUT CREEKSTATE: CAZIP CODE:
94598
CAPACITY: 6CENSUS: 6DATE:
12/03/2024
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:30 AM
MET WITH:Applicants Ninia Villanueva and Maricel EvangelistaTIME VISIT/
INSPECTION COMPLETED:
01:30 PM
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On 12/03/2024 at 8:30 AM, Licensing Program Analysts (LPAs) James Sampair and David Doidge arrived unannounced to conduct a change of ownership prelicensing visit. Upon entry into the facility, the LPAs informed Applicants Ninia Villanueva and Maricel Evangelista of the purpose of the visit.

The LPAs toured the facility inside and outside. The LPAs inspected the kitchen, common areas, bedrooms, bathrooms, and the exterior of the facility. The facility was clean, appropriately furnished, and well lit. More than the 2 days of perishable and 7 days of nonperishable food supplies were available. No body of water was on the facility grounds. Medications are centrally stored. Bathrooms and showers were observed to be fully functioning and clean. Carbon monoxide and smoke detectors were operational. The fire extinguisher was last serviced on 09/25/2024. Inside temperature was 71 degrees Fahrenheit and the hot water temperature was 110 degrees Fahrenheit.

Facility passed this prelicensing inspection. Component III training was provided for the Applicants.

Final review of the application to be completed by the Central Applications Bureau analyst.

Exit interview conducted and a copy of this report provided to the Applicant.
SUPERVISORS NAME: Harpreet Humpal
LICENSING EVALUATOR NAME: James Sampair
LICENSING EVALUATOR SIGNATURE: DATE: 12/03/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/03/2024
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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