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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 079201344
Report Date: 11/19/2024
Date Signed: 11/19/2024 12:05:56 PM

Document Has Been Signed on 11/19/2024 12:05 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
OAKLAND ASC, 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) 457-5059
CITY:WALNUT CREEKSTATE: CAZIP CODE:
94598
CAPACITY: 6CENSUS: 4DATE:
11/19/2024
TYPE OF VISIT:Post LicensingUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:15 AM
MET WITH:Administrator Dr. Nucharee (Joy) YokdangTIME VISIT/
INSPECTION COMPLETED:
12:15 PM
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On 11/19/2024 at approximately 8:15 AM, Licensing Program Analysts (LPA) James Sampair arrived unannounced to conduct the Post-Licensing Inspection. Upon entry, the LPA stated the purpose of the visit to Caregiver Pat Buasuk. Administrator Administrator Dr. Nucharee (Joy) Yokdang arrived at approximately 8:30 AM.

The LPA inspected the interior and exterior of the facility, including the kitchen, dining area, restrooms, community living spaces, resident rooms, storage areas, and the grounds of the facility. More than the required minimum of 7 days of nonperishable and 2 days of perishable foods were appropriately stored.

Temperature in the dining room was measured at 73.0 and the hot water 114.3 degrees Fahrenheit at 11:21 AM. The fire extinguishers were fully charged and last replaced on 1/16/2024.

The carbon monoxide and smoke detectors were fully operational. The LPA observed postings in the facility that included a complaint poster, Ombudsman and Personal Rights posters, Theft and Loss Policy, Rights to Resident Council, and Rights to Family Council.

An administrator is on site more than the minimum of 20 hours a week to oversee the proper business operations. The LPA reviewed facility records, records of 4 residents and staff members, and records of 5 residents. The LPA interviewed 3 residents and 3 staff members.

No citation was issued.

Exit interview conducted and a copy of this report provided.
SUPERVISORS NAME: Harpreet Humpal
LICENSING EVALUATOR NAME: James Sampair
LICENSING EVALUATOR SIGNATURE: DATE: 11/19/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/19/2024
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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