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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 075600885
Report Date: 04/09/2024
Date Signed: 04/09/2024 03:02:33 PM


Document Has Been Signed on 04/09/2024 03:02 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:BELROSE CARE HOMEFACILITY NUMBER:
075600885
ADMINISTRATOR:JUNSAY, ROSA C.FACILITY TYPE:
740
ADDRESS:209 NORMANDY LANETELEPHONE:
(925) 932-7795
CITY:WALNUT CREEKSTATE: CAZIP CODE:
94598
CAPACITY:6CENSUS: 6DATE:
04/09/2024
TYPE OF VISIT:Case Management - Health ChecksUNANNOUNCEDTIME BEGAN:
02:15 PM
MET WITH:Caregiver Venice SarionTIME COMPLETED:
03:15 PM
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On 4/9/2024 at 2:15 PM, Licensing Program Analyst (LPA) J. Sampair arrived at facility unannounced to conduct this case management visit. Upon arrival, the LPA stated the purpose of the visit to Caregivers Caregiver Venice Sarion and Salvacion Andes, which was to verify the health and safety of their new residents who were admitted on 4/6/2024 due to the fire at Casa Blanca Homes (071441125).

At 2:20 PM, the LPA and Caregivers met with Residents R1, R2, and R3. The LPA observed that all 3 residents were safe and healthy. A family member W1 of R3 was visiting and stated to the LPA that the Licensee of Casa Blanca Homes had done a "fantastic job" caring for all of the residents of the facility and that R3 was safe and healthy at their new home here.

No citations issued during this visit.

Exit interview conducted with Caregiver Venice Sarion. A copy of this report provided via email to the Licensee.
SUPERVISOR'S NAME: Harpreet HumpalTELEPHONE: (510) 529-9416
LICENSING EVALUATOR NAME: James SampairTELEPHONE: (510) 286-4201
LICENSING EVALUATOR SIGNATURE:
DATE: 04/09/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/09/2024
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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