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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 075601472
Report Date: 10/22/2020
Date Signed: 10/22/2020 11:24:01 AM

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 (ALAMO II)FACILITY NUMBER:
075601472
ADMINISTRATOR:CHOU, SETEVE & GALLO, CFACILITY TYPE:
740
ADDRESS:10 CASTLE CREST ROADTELEPHONE:
(510) 685-8388
CITY:ALAMOSTATE: CAZIP CODE:
94507
CAPACITY:6CENSUS: 5DATE:
10/22/2020
TYPE OF VISIT:Case Management - OtherANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Steve Chou, AdministratorTIME COMPLETED:
10:00 AM
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On 10/22/20 at 09:30 AM, Licensing Program Analyst (LPA), L. Hall conducted a Facetime Health and Safety check via tele-visit as a result of the department receiving a complaint. LPA conducted televisit with Administrator, Steve Chou, explained the reason for the tele-visit and that due to the present shelter in place order by the Governor the visit is done by telephone.

LPA toured facility with Administrator, including but not limited to bedrooms, kitchen, bathrooms, and common areas. LPA observed trash bins placed outside for pickup, a total of two (2) staff and two (2) residents. On today's date Residents in care appear to be safe, facility is clean and in good repair, and there are no imminent health/safety concerns. Breakfast was being served to some clients during LPA's televisit. There is a minimum of 7-day supply of non-perishable and 2-day of perishable foods.

No deficiencies cited during the health and safety check. Exit interview conducted and a copy of this report provided.
SUPERVISOR'S NAME: Harpreet HumpalTELEPHONE: (510) 285-3928
LICENSING EVALUATOR NAME: Laura HallTELEPHONE: (510) 622-2024
LICENSING EVALUATOR SIGNATURE:

DATE: 10/22/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/22/2020
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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