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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 079201465
Report Date: 01/16/2025
Date Signed: 01/16/2025 11:30:50 AM

Document Has Been Signed on 01/16/2025 11:30 AM - 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:
01/16/2025
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:30 AM
MET WITH:Licensee/Applicants, Anthony Valadez, and Armando Valadez. TIME VISIT/
INSPECTION COMPLETED:
11:55 AM
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On 01/16/2025 at 10:30AM, Licensing Program Analyst (LPA) T. Syess-Gibson arrive announced to conduct a continuance Pre-licensing Inspection from visit on 01/07/2025. LPA met with Licensee/Applicants, Anthony Valadez, and Armando Valadez.

LPA received the amended fire clearance on 01/15/2025. Fire Clearance has now been updated to rooms #2 and #3 approved for non-ambulatory.

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.

Continue on LIC809C

SUPERVISORS NAME: Harpreet Humpal
LICENSING EVALUATOR NAME: Tonica Syess-Gibson
LICENSING EVALUATOR SIGNATURE: DATE: 01/16/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/16/2025
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
OAKLAND ASC, 1515 CLAY STREET, STE. 310
OAKLAND, CA 94612
FACILITY NAME: WM RESIDENTIAL
FACILITY NUMBER: 079201465
VISIT DATE: 01/16/2025
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Continued from LIC809


A Component III was completed during the Pre-licensing continuance inspection on 01/16/2025 with Licensee/Applicants, Anthony Valadez, and Armando Valadez. The applicant was reminded of the statute that requires CCL to be notified within 5 business days of admitting their first client. This notification may be done by phone, by mail, or by fax.

No Issues were noted during inspection. LPA 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.

Exit interview conducted with Licensee/Administrator and a copy of this report provided.
SUPERVISORS NAME: Harpreet Humpal
LICENSING EVALUATOR NAME: Tonica Syess-Gibson
LICENSING EVALUATOR SIGNATURE:

DATE: 01/16/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/16/2025
LIC809 (FAS) - (06/04)
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