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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 079200745
Report Date: 03/27/2024
Date Signed: 03/27/2024 12:03:53 PM


Document Has Been Signed on 03/27/2024 12:03 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:BETHEL CARE HOME ON JUANITAFACILITY NUMBER:
079200745
ADMINISTRATOR:CHAUDHRY, TAYYABAFACILITY TYPE:
740
ADDRESS:1391 JUANITA DRIVETELEPHONE:
(925) 433-6000
CITY:WALNUT CREEKSTATE: CAZIP CODE:
94595
CAPACITY:6CENSUS: 6DATE:
03/27/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:15 AM
MET WITH:Licensee Tayyaba ChaudhryTIME COMPLETED:
12:30 PM
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On 3/27/2024 at 9:15 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 Caregivers Marlon Pamatin and Arlene Manzano who called Licensee Tayyaba Chaudhry who arrived at approximately 9:45 AM.

LPA toured the interior and exterior of the facility. LPA inspected the kitchen, dining area, restrooms, community living spaces, bathrooms, resident rooms, and the grounds of the facility. More than the required minimum of 7 days of nonperishable and 2 days of perishable foods were appropriately stored. Temperature in the living room was measured at 70.5 degrees Fahrenheit at 10:57 AM. Fire extinguisher was fully charged and last serviced on 4/27/2023. The carbon monoxide and smoke detector was fully operational. The LPA observed postings in the facility that included a complaint poster, Ombudsman and Personal Rights posters, Theft and Loss Policy, Rights to Resident Council, and Rights to Family Council.

An administrator is on site more than the minimum of 20 hours a week to oversee the proper business operations. The LPA reviewed facility records, records of 5 staff members, and records of 5 residents. The LPA interviewed 2 staff members and 2 residents.

No citations issued during inspection.

Exit interview conducted with Licensee. A copy of this report provided to the Licensee via email.
SUPERVISOR'S NAME: Harpreet HumpalTELEPHONE: (510) 529-9416
LICENSING EVALUATOR NAME: James SampairTELEPHONE: (510) 286-4201
LICENSING EVALUATOR SIGNATURE:
DATE: 03/27/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/27/2024
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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