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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 071440165
Report Date: 12/27/2024
Date Signed: 12/27/2024 04:34:55 PM

Document Has Been Signed on 12/27/2024 04:34 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:ABRAHAM REST HOMEFACILITY NUMBER:
071440165
ADMINISTRATOR/
DIRECTOR:
ABRAHAM, SARAFACILITY TYPE:
740
ADDRESS:116 VIA MONTETELEPHONE:
(925) 944-5218
CITY:WALNUT CREEKSTATE: CAZIP CODE:
94598
CAPACITY: 6TOTAL ENROLLED CHILDREN: 0CENSUS: 5DATE:
12/27/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:00 AM
MET WITH:Licensee Annette SanchezTIME VISIT/
INSPECTION COMPLETED:
02:00 PM
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On 12/27/2024 at 9:00 AM, Licensing Program Analyst (LPA) James Sampair arrived unannounced to conduct a Required Annual Inspection. Upon entry into the facility, the LPA informed Licensee Annette Sanchez of the purpose of the visit.

The LPA toured the facility inside and outside. The LPA inspected the kitchen, common areas, bedrooms, bathrooms, and the exterior of the facility. The facility was clean, appropriately furnished, and well lit. More than the 2 days of perishable and 7 days of nonperishable food supplies were available. No body of water was on the facility grounds. Medications are centrally stored. Bathrooms and showers were observed to be fully functioning and clean. The hot water temperature in the bathroom was 112.4 Fahrenheit. The room temperature of the living room was 76 Fahrenheit. Carbon monoxide and smoke detectors were operational. The fire extinguisher was last serviced on 12/10/2024.

LPA reviewed 5 resident records and 5 staff records. All were complete.

The LPA observed required postings in the facility, including the Residential Care Facility for the Elderly Complaint Poster, Ombudsman and Personal Rights posters, and the Theft and Loss Policy. An administrator is on site more than the minimum of 20 hours a week to oversee the proper business operations. Toxins and sharp objects were locked and inaccessible to participants.

Exit interview conducted and a copy of this report provided to the Applicant.
Harpreet HumpalTELEPHONE: (510) 529-9416
James SampairTELEPHONE: (510) 286-4201
DATE: 12/27/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/27/2024
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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