Community Care Licensing

Document Has Been Signed on 01/31/2025 03:28 PM - It Cannot Be Edited

FACILITY NAME:	ALPHA HOME CARE FOR SENIORS		FACILITY NUMBER:	079200584
ADMINISTRATOR/ DIRECTOR:	SUPNET, ALETA E		FACILITY TYPE:	740
ADDRESS:	1680 OBSERVATION WAY		TELEPHONE:	(925) 642-1303
CITY:	ANTIOCH	STATE: CA	ZIP CODE:	94531
CAPACITY: 6		CENSUS: 0	DATE:	01/31/2025
TYPE OF VISIT:	Case Management - Other	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	02:50 PM
MET WITH:	Aleta Supnet, Administrator		TIME VISIT/ INSPECTION COMPLETED:	05:30 PM

NARRATIVE

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On 01/31/25 at 2:50PM, Licensing Program Analyst (LPA) Daisy Panlilio conducted an unannounced case management visit to confirm that no residents are living at the home for facility closure. LPA explained the purpose of the visit with administrator (ADM). At 3PM, LPA toured the facility with ADM and observed no residents living at the facility. ADM stated that last remaining resident passed away on 03/10/24. LPA observed all COVID-19 signages, Provider Information notices, Emergency/Disaster plans, Complaint poster, Ombudsman poster and Personal rights have been removed from common areas/bathrooms. During visit, ADM surrendered their state license to LPA. ADM stated that they decided to close the facility because they wanted to have more time with family. Exit interview conducted and a copy of this report provided. Attached is facility closure email sent by administrator on 01/31/25: Facility Closing.msg

SUPERVISORS NAME: Bennett Fong LICENSING EVALUATOR NAME: Daisy Panlilio LICENSING EVALUATOR SIGNATURE: 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