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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 079200801
Report Date: 03/07/2024
Date Signed: 03/07/2024 05:13:10 PM

Document Has Been Signed on 03/07/2024 05:13 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:WESTMONT OF PINOLEFACILITY NUMBER:
079200801
ADMINISTRATOR:REMIGIO, RICHARDFACILITY TYPE:
740
ADDRESS:2850 ESTATES AVETELEPHONE:
(510) 758-1122
CITY:PINOLESTATE: CAZIP CODE:
94564
CAPACITY: 100CENSUS: 67DATE:
03/07/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
05:00 PM
MET WITH:Kathleen Boyd, Business Office ManagerTIME COMPLETED:
05:45 PM
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On 3/7/2024, Licensing Program Analyst (LPA) Carol Fowler conducted a case management visit and met with the Kathleen Boyd, Business Office Manager. LPA explained to the Administrator purpose of the visit.

During the investigation process conducted by the Department, S1 states R1 had an un-witnessed fall and was found by S2 in the bathroom on the floor, R1 was transferred to Richmond Kaiser. R1 returned to the community today 03/07/2024 and is doing well, R1 is able to transfer and take care of all activities of daily living (ADL's) with assistance.

No deficiencies issued during the visit and a copy of this report provided.

SUPERVISORS NAME: Bennett Fong
LICENSING EVALUATOR NAME: Carol Fowler
LICENSING EVALUATOR SIGNATURE: DATE: 03/07/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/07/2024
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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