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

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 079201130
Report Date: 02/07/2022
Date Signed: 02/07/2022 03:07:00 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:PROCARE RETIREMENT HOME,LLCFACILITY NUMBER:
079201130
ADMINISTRATOR:LIU, JOJANEFACILITY TYPE:
740
ADDRESS:208 SAN ANTONIO WAYTELEPHONE:
(925) 899-1200
CITY:WALNUT CREEKSTATE: CAZIP CODE:
94598
CAPACITY:6CENSUS: 0DATE:
02/07/2022
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
09:45 AM
MET WITH:Lauren May Munar and JoJane Bing LiuTIME COMPLETED:
03:30 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 02/07/2022, Licensing Program Analyst (LPA) James Sampair made an announced prelicensing inspection of facility with Applicant Lauren May Munar and Administrator JoJane Bing Liu. During the inspection of the facility inside and outside, the LPA found two deficiencies:
  1. First Aid Kit missing authorized manual
  2. 4 of the 5 bathrooms required additional grab bars

Applicant will have deficiencies resolved by 02/08/2022.
SUPERVISOR'S NAME: Harpreet HumpalTELEPHONE: (510) 285-3928
LICENSING EVALUATOR NAME: James SampairTELEPHONE: (510) 286-4201
LICENSING EVALUATOR SIGNATURE:

DATE: 02/07/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/07/2022
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