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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 075601557
Report Date: 10/03/2022
Date Signed: 10/03/2022 03:19:57 PM

Document Has Been Signed on 10/03/2022 03:19 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:
075601557
ADMINISTRATOR:ABRAHAM, SARAFACILITY TYPE:
740
ADDRESS:1035 BRIGHTWOOD COURTTELEPHONE:
(925) 286-3576
CITY:WALNUT CREEKSTATE: CAZIP CODE:
94598
CAPACITY: 6CENSUS: 6DATE:
10/03/2022
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
02:15 PM
MET WITH:Doreen KawalaTIME COMPLETED:
03:30 PM
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On 10/03/2022, Licensing Program Analyst (LPA) J. Sampair conducted an unannounced Plan of Correction (POC) inspection of the facility to verify that the POC corrections had been implemented in a manner consistent with POC dated 09/20/2022. Upon entry into the facility, the LPA identified himself and the purpose of the visit to staff member Doreen Kawala who immediately called Administrator Annette Sanchez and Alex Sanchez to come to the facility but neither of they were able to be reached by her.

Since the administrators were not present, Ms. Kawala answered questions and showed the LPA that the changes had been made in accordance with the POC, and so the POC was able to be cleared during this visit.

No citations were issued during this visit. A copy of this report was provided via email.
SUPERVISORS NAME: Harpreet Humpal
LICENSING EVALUATOR NAME: James Sampair
LICENSING EVALUATOR SIGNATURE: DATE: 10/03/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/03/2022
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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