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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 075601515
Report Date: 07/11/2023
Date Signed: 07/11/2023 03:02:58 PM


Document Has Been Signed on 07/11/2023 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:SOPHIA'S HOUSE/OUR FAMILIES FOR SENIORS, INC.FACILITY NUMBER:
075601515
ADMINISTRATOR:BERNARDINO, ALBERTOFACILITY TYPE:
740
ADDRESS:2443 AARLES COURTTELEPHONE:
(925) 954-7253
CITY:WALNUT CREEKSTATE: CAZIP CODE:
94598
CAPACITY:6CENSUS: 6DATE:
07/11/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Alberto BernardinoTIME COMPLETED:
03:30 PM
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On 07/11/2023 at 9:00 AM, Licensing Program Analyst (LPA) J. Sampair arrived unannounced at facility for required annual inspection. LPA was greeted by staff members Tristan "TJ" Almario and Mary Ann McKarson. TJ toured the facility inside and outside with LPA. At approximately 11:15 AM, Administrator (ADM) Alberto Bernardino arrived.

During the Inspection, LPA observed that the facility has a sufficient supply of food: 2 days for perishable and 7 days for nonperishable. A comfortable inside temperature of 73.4 was maintained. The facility is clean, comfortable, and odor-free.

LPA interviewed 2 residents and 2 staff members, and reviewed the records for 5 residents and 5 staff members, all of which were complete. Staff members continue to be trained and supported by the ADM in their professional development as caregivers.

No citations were issued during the inspection. A Technical Violation was issued concerning an issue that does not pose a health, safety or personal rights risk. Refer to form LIC 9102TA.

Exit interview conducted with staff members TJ and Mary Ann. A copy of this report was 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: 07/11/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/11/2023
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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