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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 12:57:32 PM

Document Has Been Signed on 07/02/2024 12:57 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:Case Management - OtherUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
11:30 AM
MET WITH:Nucharee Yokdang, AdministratorTIME VISIT/
INSPECTION COMPLETED:
01:00 PM
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LPAs Greg Clark and A. Gharachorloo conducted a face to face Component III presentation on 7/02/24. LPA met with licensee and administrator, Nucharee Yokdang.

LPAs presented Component III power point 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.

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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