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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 079200631
Report Date: 03/26/2021
Date Signed: 03/26/2021 02:53:16 PM

Document Has Been Signed on 03/26/2021 02:53 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
CCLD Regional Office, 1515 CLAY STREET, STE. 310
OAKLAND, CA 94612
FACILITY NAME:WELCOME HOME SENIOR RESIDENCE-ALAMO 3FACILITY NUMBER:
079200631
ADMINISTRATOR:CLARA DELGADOFACILITY TYPE:
740
ADDRESS:110 PASEO DE SOLTELEPHONE:
(925) 406-4921
CITY:ALAMOSTATE: CAZIP CODE:
94507
CAPACITY: 6CENSUS: 3DATE:
03/26/2021
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
02:25 PM
MET WITH:Margaret Nwanne, Care StaffTIME COMPLETED:
03:00 PM
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On 3/26/2021 at 2:25 PM, Licensing Program Analyst (LPA) L. Francisco contacted facility to conduct a case management inspection via televisit to ensure the health and safety of residents in care due to management directive. LPA spoke to Administrator, Clara Delgado and explained the purpose of televisit. Administrator stated she is currently not in the facility and provided LPA’s contact information to staff. LPA was contacted by care staff Margaret Nwanne.

During the televisit via Facetime, LPA instructed staff to start from front entrance. LPA inspected including but not limited to screening station, residents’ room, bathrooms, common areas, kitchen, and food supplies. LPA observed room temperature was maintained at 71 degrees F. Facility has electricity and running water. LPA was unable to measure hot water, however, LPA advised care staff to maintain hot water between 105 degrees F and 120 degrees F. LPA observed 2-day perishable and one week non-perishable food supply. LPA observed centrally stored medication cabinet locked. LPA observed residents appear to be well groomed.

No deficiencies cited. Exit interview with Administrator, Clara Delgado over the phone and a copy of report provided via email.
SUPERVISORS NAME: Harpreet Humpal
LICENSING EVALUATOR NAME: Lizette Francisco
LICENSING EVALUATOR SIGNATURE: DATE: 03/26/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/26/2021
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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