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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 075600885
Report Date: 12/05/2024
Date Signed: 12/05/2024 12:29:12 PM

Document Has Been Signed on 12/05/2024 12:29 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:BELROSE CARE HOMEFACILITY NUMBER:
075600885
ADMINISTRATOR/
DIRECTOR:		JUNSAY, ROSA C.FACILITY TYPE:
740
ADDRESS:209 NORMANDY LANETELEPHONE:
(925) 932-7795
CITY:WALNUT CREEKSTATE: CAZIP CODE:
94598
CAPACITY: 6TOTAL ENROLLED CHILDREN: 0CENSUS: 6DATE:
12/05/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:45 AM
MET WITH:Caregiver Venice SarionTIME VISIT/
INSPECTION COMPLETED:
12:45 PM
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On 12/05/2024 at 8:45 AM, Licensing Program Analysts (LPAs) D. Doidge and J. Sampair arrived unannounced to conduct the Required Annual Inspection of the facility. Upon arrival, LPAs stated the purpose of the visit to Caregiver Venice Sarion. Licensee Rosa Junsay arrived at approximately 10:30 AM.

The LPAs inspected the facility inside and outside. All outdoor and indoor passageways were free of obstruction. Outside, there were no bodies of water. Inside, the temperature was measured at 69 degrees Fahrenheit. The LPAs observed adequate lighting in all of the rooms for the comfort and safety of the residents. The hot water temperature in a common bathroom was measured at 116.6 degrees Fahrenheit. LPAs observed 7 days of nonperishable and 2 days of perishable foods on hand. Sharps were stored inaccessible to residents. Smoke and carbon monoxide detectors were in operating condition. Fire extinguisher was observed to be fully charged and last serviced on 12/06/2023.

The LPAs reviewed the records of 6 residents and 4 staff members all were complete.

No citation issued.

Exit interview conducted with Licensee. A copy of this report provided to the Licensee.
Bennett FongTELEPHONE: (510) 286-4201
David DoidgeTELEPHONE: (916) 475-5913
DATE: 12/05/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/05/2024
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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