<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 079200513
Report Date: 10/23/2020
Date Signed: 10/23/2020 04:53:44 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 2)FACILITY NUMBER:
079200513
ADMINISTRATOR:STEVEN CHOUFACILITY TYPE:
740
ADDRESS:807 WEAVER LANETELEPHONE:
(510) 685-8388
CITY:CONCORDSTATE: CAZIP CODE:
94518
CAPACITY:6CENSUS: 5DATE:
10/23/2020
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
03:30 PM
MET WITH:Kate Flores, Lead StaffTIME COMPLETED:
04:03 PM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
On 10/23/20 at 3:30 PM, Licensing Program Analyst (LPA) J. Hamilton met with lead staff member Kate Flores to conduct a Health and Safety 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 lead staff, including but not limited to bedrooms, kitchen, bathroom, and common areas. LPA observed a total of 5 residents and 2 staff present. LPA observed residents’ needs are being met. No imminent health or safety concerns were observed.

No deficiencies were cited. Exit interview was conducted and a copy of this report will be provided via 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)
Page: 1 of 1