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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 075601557
Report Date: 11/01/2023
Date Signed: 11/01/2023 04:01:48 PM


Document Has Been Signed on 11/01/2023 04:01 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:
075601557
ADMINISTRATOR:ABRAHAM, SARAFACILITY TYPE:
740
ADDRESS:1035 BRIGHTWOOD COURTTELEPHONE:
(925) 286-3576
CITY:WALNUT CREEKSTATE: CAZIP CODE:
94598
CAPACITY:6CENSUS: 3DATE:
11/01/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Annette SanchezTIME COMPLETED:
04:30 PM
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On 11/01/2023 at 9:30 AM, Licensing Program Analyst (LPA) J. Sampair arrived unannounced to conduct an annual inspection. Upon arrival, LPA explained the purpose of the visit to Caregiver Gina Jimenez. Administrator (ADM) Annette Sanchez arrived at approximately 10:30 AM.

During the Inspection, the LPA inspected the facility inside and outside. All outdoor and indoor passageways are kept free of obstruction. There are no bodies of water observed. A comfortable temperature is maintained at 68 degrees Fahrenheit. The LPA observed that the lighting in all rooms is adequate for the comfort and safety of the residents. Residents’ bathrooms are equipped with grab bars and non-skid mats. There is a minimum of one week supply of nonperishable and 2-day of perishable foods. Sharps were locked and inaccessible to residents. Smoke detectors and carbon monoxide detector were in operating condition. Fire extinguishers was observed to be fully charged. First aid kit was observed to be complete.

LPA interviewed 2 staff members and 2 residents, and reviewed the records of 4 staff and 3 residents.

No citations issued during visit.

Exit interview conducted with ADM Annette Sanchez. A copy of this report provided via email.
SUPERVISOR'S NAME: Bennett FongTELEPHONE: (510) -62-2621
LICENSING EVALUATOR NAME: James SampairTELEPHONE: (510) 286-4201
LICENSING EVALUATOR SIGNATURE:
DATE: 11/01/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/01/2023
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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