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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 075600534
Report Date: 10/03/2023
Date Signed: 10/03/2023 02:07:19 PM

Document Has Been Signed on 10/03/2023 02:07 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:JONED'S REST HOMEFACILITY NUMBER:
075600534
ADMINISTRATOR:BASBAS, JULIETA C.FACILITY TYPE:
740
ADDRESS:2724 VENADO CAMINOTELEPHONE:
(925) 945-6632
CITY:WALNUT CREEKSTATE: CAZIP CODE:
94598
CAPACITY: 6CENSUS: 6DATE:
10/03/2023
TYPE OF VISIT:Case Management - Annual ContinuationUNANNOUNCEDTIME BEGAN:
12:00 PM
MET WITH:Licensee Julieta BasbasTIME COMPLETED:
02:30 PM
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On 10/03/2023 at 12:00 PM, Licensing Program Analyst (LPA) J. Sampair arrived unannounced at facility to complete required annual inspection. LPA was greeted by Licensee Julieta Basbas.

During the Inspection, LPA reviewed files of 5 residents and 5 staff members.

Annual inspection complete.

No citations issued during inspection.

Exit interview conducted with Licensee and a copy of this report was provided via email.
SUPERVISORS NAME: Bennett Fong
LICENSING EVALUATOR NAME: James Sampair
LICENSING EVALUATOR SIGNATURE: DATE: 10/03/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/03/2023
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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