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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 079201310
Report Date: 11/26/2024
Date Signed: 11/26/2024 12:27:28 PM

Document Has Been Signed on 11/26/2024 12:27 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:GOLD CREST SENIOR LIVINGFACILITY NUMBER:
079201310
ADMINISTRATOR/
DIRECTOR:
PAPA, WILHELMINAFACILITY TYPE:
740
ADDRESS:40 GOLD CREST COURTTELEPHONE:
(415) 481-8609
CITY:PITTSBURGSTATE: CAZIP CODE:
94565
CAPACITY: 6CENSUS: 0DATE:
11/26/2024
TYPE OF VISIT:PrelicensingANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:20 AM
MET WITH:Wilhelmina Papa, Administrator/ Vanessa Aquino, LicenseeTIME VISIT/
INSPECTION COMPLETED:
11:25 AM
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On 11/26/2024 at 10:20AM, Licensing Program Analysts (LPAs) L. Hall and D. Doidge conducted an announced pre-licensing inspection. LPAs met with Wilhelmina Papa, Administrator, and Vanessa Aquino, Licensee. The facility has an approved fire safety clearance for two (2) ambulatory and four (4) non-ambulatory residents.

LPA inspected the facility inside and out including but not limited to the bedrooms, bathrooms, common living areas, kitchen, garage, back yard. The facility has a total of four (4) bedrooms and two (2) bathrooms. No bodies of water observed. There is sufficient lighting around the facility. Residents rooms are equipped with the proper furniture, bedding, and lighting. Passageways and hallways are free of obstruction. Locked cabinets available to store medications, toxins and sharps. Hot water temperature is measured at 107.3 degrees Fahrenheit in shared residents' bathroom. Fire extinguisher was last purchased on 04/2024. There is a minimum of 7-day non-perishables and 2-day perishables foods. First Aid kit was complete. Carbon monoxide and smoke detectors present. Facility inspection matches the sketch that was provided.

No Issues were noted during inspection. LPA observed that facility is ready to be licensed. This report will be submitted to the Central Applications Unit (CAU) and a final review of the application will be conducted. This facility is not yet licensed and is subject to final approval by CAU. Additional requirements may still be required.

Exit interview conducted with Administrator and a copy of this report provided.
SUPERVISORS NAME: Harpreet Humpal
LICENSING EVALUATOR NAME: Laura Hall
LICENSING EVALUATOR SIGNATURE: DATE: 11/26/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/26/2024
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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