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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 075600662
Report Date: 02/05/2025
Date Signed: 02/05/2025 12:55:19 PM

Document Has Been Signed on 02/05/2025 12:55 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
CCLD Regional Office, 1515 CLAY STREET, STE. 310
OAKLAND, CA 94612
FACILITY NAME:ABRAHAM REST HOMEFACILITY NUMBER:
075600662
ADMINISTRATOR/
DIRECTOR:		SARA ABRAHAMFACILITY TYPE:
740
ADDRESS:5132 NATHALEETELEPHONE:
(925) 676-9021
CITY:CONCORDSTATE: CAZIP CODE:
94521
CAPACITY: 6CENSUS: 5DATE:
02/05/2025
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
12:43 PM
MET WITH:JULIO SANCHEZ, ADMINISTRATORTIME VISIT/
INSPECTION COMPLETED:
01:15 PM
NARRATIVE
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While conducting an investigation of a complaint (Control # 15-AS-20250203153446), the Department observed that staff (S1) has not been fingerprint cleared.

On this day, 2/5/2025, Licensing Program Analyst (LPA) Carol Fowler conducted a case management as a result of the above. LPA met with Administrator (ADM) Julio Sanchez.

Deficiency is cited from Title 22 California Code of Regulations and listed on 809D. Failure to submit proof of correction by plan of correction due date and any repeat violation within 12-month period may result in civil penalty.

Deficiency and plan and proof of correction were discussed with administrator.

Exit interview conducted. A copy of this report, Appeal Rights and , .
SUPERVISORS NAME: Bennett Fong
LICENSING EVALUATOR NAME: Carol Fowler
LICENSING EVALUATOR SIGNATURE: DATE: 02/05/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/05/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 2
Document Has Been Signed on 02/05/2025 12:55 PM - It Cannot Be Edited


Created By: Carol Fowler On 02/05/2025 at 12:32 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 1515 CLAY STREET, STE. 310
OAKLAND, CA 94612

FACILITY NAME: ABRAHAM REST HOME
FACILITY NUMBER: 075600662

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/05/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
02/10/2025
Section Cited
CCR
87355(e)(2)

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87355(e)(2)
Criminal Record Clearance. Prior to working, residing or volunteering in a licensed facility, all individuals subject to a criminal record review shall request a transfer of a criminal record clearance from another facility or Trustline.
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Licensee/Administrator shall ensure that all employees prior to start date have been criminally cleared and associated to facility. Administrator to verify with CCLD that employees have an active association to facility before allowing to work.
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-This requirement is not met as evidenced by:
-Based on records review and interviews, the licensee did not comply with the section above by allowing statt (S1) to work and was without being finger print cleared. personal rights risks to persons in care.
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 Administrator shall submit to CCLD LIC 9182 to associate any and all staff members whom are currently not associated to facility by POC date.

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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Bennett Fong
LICENSING EVALUATOR NAME:Carol Fowler
LICENSING EVALUATOR SIGNATURE:
DATE: 02/05/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/05/2025


LIC809 (FAS) - (06/04)
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