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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 075601180
Report Date: 03/26/2021
Date Signed: 03/26/2021 12:30:05 PM

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:WELCOME HOME SENIOR RESIDENCE (WALNUT CREEK)FACILITY NUMBER:
075601180
ADMINISTRATOR:CHOU, STEVEFACILITY TYPE:
740
ADDRESS:2421 WASDEN COURTTELEPHONE:
(925) 944-0204
CITY:WALNUT CREEKSTATE: CAZIP CODE:
94598
CAPACITY:6CENSUS: 2DATE:
03/26/2021
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
11:30 AM
MET WITH:Gladys Enriquez/StaffTIME COMPLETED:
12:30 PM
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Licensing Program Analyst (LPA) Delmundo called the facility and spoke with Gladys Min Enriquez, staff. LPA to conduct a case management inspection to ensure the health and safety of residents in care. LPA informed the purpose of call and that due to management directive to telework, inspection will be conducted via video conference. LPA also called and spoke with Steve Chou who indicated he's not available to come to the facility.

LPA conducted inspection with Gladys Min Enriquez.. LPA requested her to tour LPA to the facility starting from the front door. LPA observed hand sanitizer, thermometer and a log sheet by the entrance door. LPA inspected the bedrooms, bathroom, living and dining rooms and kitchen. Facility currently has 2 residents who were present during inspection. Both residents appeared well taken care off. LPA also met with other on-duty staff, Francis Escalante.

LPA inspected the food supplies which were observed sufficient good for 2 days of perishables and 7 days of non-perishables. Hallways were observed clear of obstructions. Facility has running water and electricity. Hot water in the bathroom was tested and measured at 110 degrees Fahrenheit.

No deficiencies observed during inspection.

Copy of this report provided to Steve Chou via e-mail.
SUPERVISOR'S NAME: Isaac TaggartTELEPHONE: (510) 363-5912
LICENSING EVALUATOR NAME: Alicia DelmundoTELEPHONE: (510) 286-4201
LICENSING EVALUATOR SIGNATURE:

DATE: 03/26/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/26/2021
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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