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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 075601570
Report Date: 10/23/2020
Date Signed: 10/23/2020 04:53:15 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(CONCORD)FACILITY NUMBER:
075601570
ADMINISTRATOR:CHOU, STEVEFACILITY TYPE:
740
ADDRESS:1780 PEACH PLACETELEPHONE:
(510) 685-8388
CITY:CONCORDSTATE: CAZIP CODE:
94518
CAPACITY:6CENSUS: 4DATE:
10/23/2020
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
02:30 PM
MET WITH:Gene Silvan, AdministratorTIME COMPLETED:
02:57 PM
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On 10/23/20 at 2:30 PM, Licensing Program Analyst (LPA) J. Hamilton met with administrator Gene Silvan to conduct a Health and Safety tele-visit in response to a complaint received by the Department. Due to the Governor’s shelter-in-place order this visit was conducted via videoconference.

LPA toured facility with administrator, including but not limited to bedrooms, kitchen, bathroom, and common areas. LPA observed a total of 4 residents and 2 staff members present. LPA observed residents’ needs are currently being met. No imminent health or safety concerns were observed.

No deficiencies cited. Exit interview was conducted and a copy of this report will be provided by email.
SUPERVISOR'S NAME: Isaac TaggartTELEPHONE: (510) 622-2610
LICENSING EVALUATOR NAME: Jason HamiltonTELEPHONE: (510) 622-2647
LICENSING EVALUATOR SIGNATURE:

DATE: 10/23/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/23/2020
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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