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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 079201344
Report Date: 07/02/2024
Date Signed: 07/02/2024 12:56:22 PM

Document Has Been Signed on 07/02/2024 12:56 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:WIMBLEDON WALNUT CREEK CARE HOMEFACILITY NUMBER:
079201344
ADMINISTRATOR/
DIRECTOR:		YOKDANG, NUCHAREEFACILITY TYPE:
740
ADDRESS:727 WIMBLEDON RDTELEPHONE:
(925) 457-5587
CITY:WALNUT CREEKSTATE: CAZIP CODE:
94598
CAPACITY: 6CENSUS: 0DATE:
07/02/2024
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:30 AM
MET WITH:NUCHAREE YOKDANG, ADMINISTRATORTIME VISIT/
INSPECTION COMPLETED:
11:30 AM
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On 7/02/24 at 10:30 AM, Licensing Program Analysts (LPAs) Greg Clark and A. Gharachorloo arrived announced to conduct pre-licensing inspection. LPA met with Nucharee Yokdang, Administrator and explained the purpose of the visit. The facility currently has no residents/clients.

LPAs toured facility including but not limited to bedrooms, bathrooms, kitchen, common areas, pool and backyard. Bedrooms and living rooms were equipped with the proper furniture. Bathrooms were equipped with grab bars and non-skid mats. Linens and hygiene supplies were observed inside a cabinet. There is sufficient lighting throughout facility. Room temperature was maintained at 72 degrees F and hot water temperature was maintained at 113 degrees F. First-aid kit was observed to be complete. Smoke detectors and carbon monoxide were operational. Fire extinguisher was last serviced on 1/16/24.

No issues noted during inspection. LPAs 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 and a copy of this report provided.
SUPERVISORS NAME: Yvonne Flores-Larios
LICENSING EVALUATOR NAME: Gregory Clark
LICENSING EVALUATOR SIGNATURE: DATE: 07/02/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/02/2024
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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