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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 075601180
Report Date: 01/17/2025
Date Signed: 01/28/2025 12:01:51 PM

Document Has Been Signed on 01/28/2025 12:01 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:WELCOME HOME SENIOR RESIDENCE (WALNUT CREEK)FACILITY NUMBER:
075601180
ADMINISTRATOR/
DIRECTOR:
CHOU, STEVEFACILITY TYPE:
740
ADDRESS:2421 WASDEN COURTTELEPHONE:
(925) 944-0204
CITY:WALNUT CREEKSTATE: CAZIP CODE:
94598
CAPACITY: 6TOTAL ENROLLED CHILDREN: 0CENSUS: 4DATE:
01/17/2025
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:00 PM
MET WITH:Excutive Director Racquel FloresTIME VISIT/
INSPECTION COMPLETED:
04:15 PM
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On 1/17/2024 at 1:00 PM, Licensing Program Analyst (LPA) James Sampair arrived unannounced to conduct an annual required inspection. The LPA informed Staff Members Fe Alolod and Salve (Regina) Piquing of the reason for visit. At approximately 1:30 PM, Executive Director (ED) Racquel Flores and Licensee Steve Chou arrived at the facility.

The LPA inspected the facility inside and outside with the staff and licensee. The inspection included the kitchen, dining area, living room, bedrooms, bathrooms, and yards. An adequate amount of food supplies were observed, more than the required minimum of 2 days of perishable and 7 days of non-perishable food. The central storage for medications and cleaning supplies were stored in locked cabinets.

Facility has a fully functioning 2-in-1 smoke and carbon monoxide detector. Facility conducts disaster/emergency and fire drills on a quarterly basis; records showed that the most recent drill was conducted on 10/24/2024. The fire extinguisher was fully charged and last serviced on 11/18/2024. The indoor temperature in the living room was 68.4 degrees Fahrenheit and the maximum hot water temperature was 110.4 degrees Fahrenheit, both within the acceptable temperature range.

The LPA reviewed 4 resident and 5 staff records.

No citations were issued during this inspection.

Exit interview conducted and a copy of this report provided.
Harpreet HumpalTELEPHONE: (510) 529-9416
James SampairTELEPHONE: (510) 286-4201
DATE: 01/17/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/17/2025
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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