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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 079200513
Report Date: 03/22/2021
Date Signed: 03/22/2021 05:17:04 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 2)FACILITY NUMBER:
079200513
ADMINISTRATOR:STEVEN CHOUFACILITY TYPE:
740
ADDRESS:807 WEAVER LANETELEPHONE:
(510) 685-8388
CITY:CONCORDSTATE: CAZIP CODE:
94518
CAPACITY:6CENSUS: 5DATE:
03/22/2021
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
03:33 PM
MET WITH:Steve Chou/AdministratorTIME COMPLETED:
04:15 PM
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At 3:33 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 called and spoke with staff, Racquel Flores. LPA requested her 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. All four residents are in the facility in their bedrooms while the other one, according to Racquel. is at rehab. All residents appeared well taken care off. LPA also met with other on-duty staff, Francisco Francisco.

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 111.7 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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