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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 079201465
Report Date: 01/07/2025
Date Signed: 01/07/2025 03:57:47 PM

Document Has Been Signed on 01/07/2025 03:57 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:WM RESIDENTIALFACILITY NUMBER:
079201465
ADMINISTRATOR/
DIRECTOR:		VALADEZ, ANTHONYFACILITY TYPE:
735
ADDRESS:1240 WALNUT MEADOWS DRIVETELEPHONE:
(925) 457-0913
CITY:OAKLEYSTATE: CAZIP CODE:
94561
CAPACITY: 4CENSUS: 0DATE:
01/07/2025
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
02:23 PM
MET WITH:Anthony Valadez, and Armando Valadez, Licensee/AdministratorTIME VISIT/
INSPECTION COMPLETED:
04:10 PM
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On 01/07/2025 at 2:23PM, Licensing Program Analyst (LPA) T. Syess-Gibson conducted a Pre-licensing Inspection. LPA met with Licensee/Applicants, Anthony Valadez, and Armando Valadez.


LPA toured facility including but not limited to client's bedrooms, bathrooms, living room, dining area, kitchen, garage, and outdoor area. LPA observed lighting in all rooms. LPA observed facility had some non-perishable food supply. Licensee will purchase additional food supplies once facility is licensed. Carbon monoxide detector was observed in operating condition. First aid kit was complete. Emergency disaster plan was complete.

While LPA was reviewing the facility's fire clearance, LPA observed the facility is approved for two (2) ambulatory and two (2) non-ambulatory clients. However, the inspector’s notes on the fire clearance indicates room#1 and room#2 are approved for non-ambulatory clients. The facility sketch indicates room# 2 and room#3 are for non-ambulatory clients.



LPA called Fire Inspector to explain what was observed, the Fire Inspector stated will send another Fire Clearance to CAB with the correct room numbers for non-ambulatory clients.

Pre licensing was not completed and will be scheduled once the corrected fire clearance is received.

Comp III will be conducted on next visit.

Exit interview conducted and a copy of this report provided.

SUPERVISORS NAME: Harpreet Humpal
LICENSING EVALUATOR NAME: Tonica Syess-Gibson
LICENSING EVALUATOR SIGNATURE: DATE: 01/07/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/07/2025
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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