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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 075601579
Report Date: 01/31/2025
Date Signed: 01/31/2025 06:35:21 PM

Document Has Been Signed on 01/31/2025 06:35 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:WALNUT CREEK SENIOR LIVINGFACILITY NUMBER:
075601579
ADMINISTRATOR/
DIRECTOR:		DONALD T. HAYFACILITY TYPE:
740
ADDRESS:80 CRAGMONT COURTTELEPHONE:
(925) 939-3635
CITY:WALNUT CREEKSTATE: CAZIP CODE:
94598
CAPACITY: 8TOTAL ENROLLED CHILDREN: 0CENSUS: 5DATE:
01/31/2025
TYPE OF VISIT:POCUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
12:30 PM
MET WITH:Licensee Donald HayTIME VISIT/
INSPECTION COMPLETED:
07:00 PM
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On January 31, 2025 at 12:30 PM, Licensing Program Analyst (LPA) James Sampair arrived for this unannounced Plan of Correction (POC) visit. Upon entry to the facility, the LPA informed Caregiver Blessilda Luna of the purpose of the visit. Licensee Donald Hay arrived at approximately 1:15 PM.

The LPA reviewed the documentation in progress with the Licensee that was related to the 5 POCs. 1 of the POCs was cleared. Due to the progress being made by the Licensee on completing the other 4 POCs, the LPA gave an extension to February 28, 2025 for them to be completed.

No citations issued.

Exit interview conducted and a copy of this report provided.
Harpreet HumpalTELEPHONE: (510) 529-9416
James SampairTELEPHONE: (510) 286-4201
DATE: 01/31/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/31/2025
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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