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Department of
SOCIAL SERVICES
Community Care Licensing
FACILITY EVALUATION REPORT
Facility Number:
079201460
Report Date:
12/30/2024
Date Signed:
12/30/2024 01:17:05 PM
Document Has Been Signed on
12/30/2024 01:17 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:
BUTTERCUP CARE HOME
FACILITY NUMBER:
079201460
ADMINISTRATOR/
DIRECTOR:
SCHAEFER, IRAIS A.
FACILITY TYPE:
740
ADDRESS:
993 OAK GROVE ROAD
TELEPHONE:
(562) 673-0803
CITY:
CONCORD
STATE:
CA
ZIP CODE:
94518
CAPACITY:
6
CENSUS:
3
DATE:
12/30/2024
TYPE OF VISIT:
Case Management - Other
UNANNOUNCED
TIME VISIT/
INSPECTION BEGAN:
12:00 PM
MET WITH:
Irais Schaefer, Administrator
TIME VISIT/
INSPECTION COMPLETED:
01:30 PM
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LPA conducted Component III with Licensee and Administrator. LPA presented Component III Power Point and discussed the regulations embodied in the presentation.
Exit interview conducted and a copy of this report will be provided.
SUPERVISORS NAME
:
Harpreet Humpal
LICENSING EVALUATOR NAME
:
Jill Clancy-Czuleger
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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