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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 079200745
Report Date: 03/12/2025
Date Signed: 03/12/2025 05:02:09 PM

Document Has Been Signed on 03/12/2025 05:02 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/
DIRECTOR:		CHAUDHRY, TAYYABAFACILITY TYPE:
740
ADDRESS:1391 JUANITA DRIVETELEPHONE:
(925) 433-6000
CITY:WALNUT CREEKSTATE: CAZIP CODE:
94595
CAPACITY: 6CENSUS: 5DATE:
03/12/2025
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:30 PM
MET WITH:Administrator Tayyaba ChaudhryTIME VISIT/
INSPECTION COMPLETED:
05:30 PM
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On 03/12/2025 at 1:30 PM, Licensing Program Analysts (LPAs) Y. Brown and J. Sampair arrived unannounced to conduct the Required Annual Inspection of the facility. Upon arrival, LPAs stated the purpose of the visit to Administrator Tayyaba Chaudhry.

The LPAs inspected the facility inside and outside. All outdoor and indoor passageways were free of obstruction. Outside, there were no bodies of water. Inside, the temperature was measured at 71 degrees Fahrenheit.

The LPAs observed adequate lighting in all of the rooms for the comfort and safety of the residents. The hot water temperature in a common bathroom was in a safe temperature range. LPAs observed 7 days of nonperishable and 2 days of perishable foods on hand. Sharps were stored inaccessible to residents. Smoke and carbon monoxide detectors were in operating condition. Fire extinguisher was observed to be fully charged and last serviced on

The LPAs reviewed the records of 5 residents and 5 staff members all were complete.

No citation issued.

Exit interview conducted with Licensee. A copy of this report provided to the Licensee.
SUPERVISORS NAME: Harpreet Humpal
LICENSING EVALUATOR NAME: James Sampair
LICENSING EVALUATOR SIGNATURE: DATE: 03/12/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/12/2025
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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