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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 12:28:38 PM

Document Has Been Signed on 11/26/2024 12:28 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:Case Management - OtherUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
11:25 AM
MET WITH:Wilhelmina Papa, Administrator/ Vanessa Aquino, LicenseeTIME VISIT/
INSPECTION COMPLETED:
12:35 PM
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On 11/26/2024 at 10:50am, Licensing Program Analysts (LPAs), L. Hall and D. Doidge arrived to conduct an announced case management visit. LPAs met with Wilhelmina Papa, Administrator/ Vanessa Aquino, Licensee, and explained the purpose of the visit.

LPAs presented Component III power point during visit and discussed the regulations embodied in the power point. LPAs observed the participants gained knowledge about running and maintaining the facility in accordance with regulations.

A license has not yet been granted to this facility. Licensure is subject to final review and approval by the Centralized Applications Unit. Licensee is not to accept consumers until notified by Community Care Licensing that the license has been approved.

No deficiencies cited during visit.

Exit interview conducted 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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