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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 075601492
Report Date: 10/03/2023
Date Signed: 10/03/2023 11:48:15 AM

Document Has Been Signed on 10/03/2023 11:48 AM - 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 HOME IIFACILITY NUMBER:
075601492
ADMINISTRATOR:BASBAS, EDGARDO G.FACILITY TYPE:
740
ADDRESS:141 VIA MONTETELEPHONE:
(925) 323-4463
CITY:WALNUT CREEKSTATE: CAZIP CODE:
94598
CAPACITY: 6CENSUS: 6DATE:
10/03/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:15 AM
MET WITH:Julieta BasbasTIME COMPLETED:
12:00 PM
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On 10/03/2023 at 9:15 AM, Licensing Program Analyst (LPA) J. Sampair arrived unannounced at facility for required annual inspection. LPA was greeted by staff member Manuel Basbas. Licensee Julieta Basbas arrived at approximately 9:45 AM.

During the Inspection, LPA interviewed 2 residents and 2 staff members. LPA and Licensee inspected the facility inside and outside. LPA observed that the facility has a sufficient supply of food: 2 days perishable and 7 days nonperishable. A comfortable inside temperature of 72.8 degrees F was maintained. The facility was clean and the staff attentive to residents' needs.

No citations issued during the 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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