<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 071440577
Report Date: 02/21/2025
Date Signed: 02/21/2025 12:17:31 PM

Document Has Been Signed on 02/21/2025 12:17 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:MERCY CARE HOMEFACILITY NUMBER:
071440577
ADMINISTRATOR/
DIRECTOR:		FLORENTINA BUDOMOFACILITY TYPE:
740
ADDRESS:272 EL DIVISADEROAVE.TELEPHONE:
(925) 935-1785
CITY:WALNUT CREEKSTATE: CAZIP CODE:
94598
CAPACITY: 6TOTAL ENROLLED CHILDREN: 0CENSUS: 3DATE:
02/21/2025
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:00 AM
MET WITH:Licensee / Administrator Florentina BudomoTIME VISIT/
INSPECTION COMPLETED:
12:30 PM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
On February 21, 2025 at 9:00 AM, Licensing Program Analyst (LPA) James Sampair arrived unannounced to conduct an annual required inspection. The LPA informed Licensee / Administrator Florentina Budomo of the reason for visit.

The LPA inspected the inside and outside of the facility with the Licensee. The inspection included the kitchen, dining area, living room, bedrooms, bathrooms, and yard. An adequate amount of food supplies were observed, more than the required minimum of 2 days of perishable and 7 days of non-perishable food. The central storage for medications was locked. The cleaning supplies and dangerous objects were stored in locked cabinets.

Facility has working smoke and carbon monoxide detectors. Facility conducts disaster/emergency and fire drills on a quarterly basis; records showed that the most recent drill was conducted on January 6, 2025. Fire extinguisher was fully charged and last replaced on March 12, 2024. The indoor temperature and the maximum hot water temperatures were in the acceptable range.

The LPA reviewed 3 resident and 5 staff records.

Exit interview conducted and a copy of this report provided.
Harpreet HumpalTELEPHONE: (510) 529-9416
James SampairTELEPHONE: (510) 286-4201
DATE: 02/21/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/21/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 1