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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 079201216
Report Date: 09/21/2022
Date Signed: 09/21/2022 12:11:24 PM


Document Has Been Signed on 09/21/2022 12:11 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:CASTLE CREST HOME IFACILITY NUMBER:
079201216
ADMINISTRATOR:SANTOS, BENJAMINFACILITY TYPE:
740
ADDRESS:113 CREST AVENUETELEPHONE:
(925) 285-1130
CITY:ALAMOSTATE: CAZIP CODE:
94507
CAPACITY:6CENSUS: 0DATE:
09/21/2022
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
10:20 AM
MET WITH:Jude Velasco, LicenseeTIME COMPLETED:
12:20 PM
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On 9/21/2022 starting at 10:20 AM, Licensing Program Analyst (LPA) L. Francisco conducted an announced Pre-Licensing Inspection due to change of location. LPA met with Licensee, Jude Velasco. The facility's fire clearance is approved for 5 non-ambulatory and 1 ambulatory residents.

LPA toured facility with Licensee including but not limited to bedrooms, bathrooms, kitchen, common areas and backyard. Bathrooms for residents were equipped with grab bars and non-skid mats. Room temperature is maintained at 68 degrees F. Linens were observed stored in hallway closet. Hygienes supplies will be provided by facility There is sufficient lighting throughout facility. There is a 2-day perishable and one week non-perishable food supply. First-aid kit was observed to be complete. Smoke detectors and carbon monoxide were operational. Fire extinguisher was last serviced on 9/2/2022. Residents will be moving in starting on 9/22/2022 along with their beds and chest of drawers.

No issues noted during inspection. LPAs observed that facility is ready to be licensed. This report will be submitted to the Central Applications Unit (CAU) and a final review of the application will be conducted. This facility is not yet licensed, and is subject to final approval by CAU. Additional requirements may still be required.

Comp III is being waived. Licensee operates another sister facility.

Exit interview conducted and a copy of this report provided.
SUPERVISOR'S NAME: Harpreet HumpalTELEPHONE: (510) 285-3928
LICENSING EVALUATOR NAME: Lizette FranciscoTELEPHONE: (510) 286-4201
LICENSING EVALUATOR SIGNATURE:
DATE: 09/21/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/21/2022
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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