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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 079201244
Report Date: 05/03/2023
Date Signed: 05/03/2023 12:01:34 PM


Document Has Been Signed on 05/03/2023 12:01 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
E BAY DELTA AC/SC, 1515 CLAY STREET, STE. 310
OAKLAND, CA 94612



FACILITY NAME:HOME SWEET WILSONFACILITY NUMBER:
079201244
ADMINISTRATOR:SORIANO, CHRISTINE TFACILITY TYPE:
740
ADDRESS:4248 WILSON LNTELEPHONE:
(510) 507-2679
CITY:CONCORDSTATE: CAZIP CODE:
94521
CAPACITY:6CENSUS: 5DATE:
05/03/2023
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
09:35 AM
MET WITH:Christine Soriano, AdministratorTIME COMPLETED:
11:35 AM
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On 05/03/2023 at 9:35 AM, Licensing Program Analyst (LPA) P. Watson arrived announced to conduct Pre-Licensing inspection. LPA met with Administrator, Christine Soriano and explained the purpose of the visit. The facility currently has 5 residents.

LPA toured facility with Christine including but not limited to 7 bedrooms, 2 bathrooms, kitchen, common areas and backyard. Bedrooms and living rooms were equipped with the proper furniture. Bathrooms were equipped with grab bars and non-skid mats. Linens and hygiene supplies were observed inside the closet. There is sufficient lighting throughout facility. Room temperature was maintained at 70 degrees Fahrenheit and hot water temperature was maintained at 114.6 degrees Fahrenheit. First-aid kit was observed to be complete. Smoke detectors and carbon monoxide were operational condition. Fire extinguisher was last serviced on 05/04/2022.


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


Exit interview conducted and a copy of this report provided.
SUPERVISOR'S NAME: Yvonne Flores-LariosTELEPHONE: (510) 725-7926
LICENSING EVALUATOR NAME: Paris WatsonTELEPHONE: (510) 622-2625
LICENSING EVALUATOR SIGNATURE:
DATE: 05/03/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/03/2023
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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