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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 075601570
Report Date: 03/22/2021
Date Signed: 03/22/2021 05:15:04 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:
03/22/2021
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
04:22 PM
MET WITH:Steve Chou/AdministratorTIME COMPLETED:
05:15 PM
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At 4:22 pm on this day, March 22, 2021, Licensing Program Analyst (LPA) Delmundo called and spoke with Steve Chou, administrator, 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. Steve Chou indicated he's currently not in the facility and provided to LPA the contact information of the staff.

LPA spoke with staff, Jean Silvan. Also present and on-duty is staff, Abner Silvan. LPA requested Jean Silvan to tour LPA to the facility starting from the front door. LPA observed hand sanitizer, thermometer and a log sheet close to the entrance door. Three residents were observed in the common area while the other one in the bedroom. All residents appeared well taken care off.

LPA inspected the food supplies which were observed sufficient good for 2 days of perishables and 7 days of non-perishables. Facility was observed clear of obstructions, has running water and electricity. Hot water 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: 03/22/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/22/2021
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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