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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 071440165
Report Date: 12/18/2023
Date Signed: 12/18/2023 12:38:34 PM


Document Has Been Signed on 12/18/2023 12:38 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:ABRAHAM, SARAFACILITY TYPE:
740
ADDRESS:116 VIA MONTETELEPHONE:
(925) 944-5218
CITY:WALNUT CREEKSTATE: CAZIP CODE:
94598
CAPACITY:6CENSUS: 6DATE:
12/18/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Annette SanchezTIME COMPLETED:
01:00 PM
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On 12/18/2023 at 09:30 AM, Licensing Program Analyst (LPA) J. Sampair arrived unannounced to conduct the Required Annual Inspection of the facility. Upon arrival, LPA stated the purpose of the visit to Staff Member Yanira "Jenny" Duran. Administrator (ADM) Annette Sanchez arrived at approximately 10:15 AM and Licensee Sara Abraham at approximately 12:00 PM.

LPA toured facility inside and outside with ADM. All outdoor and indoor passageways were free of obstruction. There were no bodies of water observed. Inside, the temperature was measured at a comfortable 70.6 degrees and the hot water was 107.4 degrees Fahrenheit. The LPA observed adequate lighting in all of the rooms for the comfort and safety of the residents. LPA observed 7 days of nonperishable and 2 days of perishable foods on hand. Sharps and dangerous items were inaccessible to residents. Smoke and carbon monoxide detectors were in operating condition. Fire extinguisher was observed to be fully charged and last serviced on 12/23/2022.

The LPA reviewed the records of 5 residents and 5 staff members. The LPA interviewed 2 residents and 2 staff members.

No citations were issued.

Exit interview conducted with Licensee Sara Abraham. A copy of this report provided via email to the ADM.
SUPERVISOR'S NAME: Bennett FongTELEPHONE: (510) -62-2621
LICENSING EVALUATOR NAME: James SampairTELEPHONE: (510) 286-4201
LICENSING EVALUATOR SIGNATURE:
DATE: 12/18/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/18/2023
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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