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

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 079200628
Report Date: 03/13/2025
Date Signed: 03/13/2025 12:08:39 PM

Document Has Been Signed on 03/13/2025 12:08 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:ELWYN CALIFORNIA - CHEYENNEFACILITY NUMBER:
079200628
ADMINISTRATOR/
DIRECTOR:		VIGO, CONCEPCIONFACILITY TYPE:
734
ADDRESS:906 CHEYENNE DRTELEPHONE:
(925) 300-3958
CITY:WALNUT CREEKSTATE: CAZIP CODE:
94598
CAPACITY: 5CENSUS: 5DATE:
03/13/2025
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:00 AM
MET WITH:Administrator Paolo Paredes TIME VISIT/
INSPECTION COMPLETED:
12:30 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 3/13/2025 at 9:00 AM, Licensing Program Analyst (LPA) J. Sampair and Y. Brown arrived unannounced to conduct the Required Annual Inspection of the facility. Upon arrival, LPA stated the purpose of the visit to Administrator Paolo Paredes.

LPA toured the interior and exterior of the facility. LPA inspected the kitchen, dining area, restrooms, community living spaces, bathrooms, resident rooms, and the grounds of the facility. More than the required minimum of 7 days of nonperishable and 2 days of perishable foods were appropriately stored. The hot water was measured at a safe temperature range of 105.0. Temperature in the living room was 70.3 degrees Fahrenheit at 10:17 AM. Fire extinguisher was fully charged and last serviced on 3/12/2025. Carbon monoxide and smoke detectors were fully operational. The LPA observed that there were no bodies of water at the facility. An administrator is on site more than the minimum of 20 hours a week to ensure that proper business operations are being conducted. The LPA reviewed facility records, records of 5 staff members, and records of 5 residents.

No citations issued during this visit.

Exit interview conducted with ADM and a copy of this report provided via email to the ADM.
SUPERVISORS NAME: Harpreet Humpal
LICENSING EVALUATOR NAME: James Sampair
LICENSING EVALUATOR SIGNATURE: DATE: 03/13/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/13/2025
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