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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 019200474
Report Date: 12/14/2022
Date Signed: 12/14/2022 01:07:31 PM


Document Has Been Signed on 12/14/2022 01:07 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:STONERIDGE CREEK PLEASANTONFACILITY NUMBER:
019200474
ADMINISTRATOR:EZEKIEL GRIFFINFACILITY TYPE:
741
ADDRESS:3300 STONERIDGE CREEK WAYTELEPHONE:
(925) 201-4000
CITY:PLEASANTONSTATE: CAZIP CODE:
94588
CAPACITY:828CENSUS: 785DATE:
12/14/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
11:10 AM
MET WITH:Ezekiel Griffin, AdminstratorTIME COMPLETED:
01:20 PM
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On 12/14/22 at 11:10 AM, Licensing Program Analyst (LPA) K. Nguyen conducted an unannounced required one-year infection control inspection and met with Administrator (ADM) Ezekiel Griffin at the Clubhouse. LPA explained the purpose of the visit to ADM which was to complete the required one year infection control inspection.

This facility is an independent living part of the Community Care Retirement Communities (CCRC) composed of five separate four story per site plan - The Tahoe, Eldorado, Shasta, Mendocino and Lassen. In addition to these buildings are the Garden Terraces (GT) units - North has three floors and South has two floors. Along the perimeter of the GT units are the Villas (six category townhouses with private garages ranging from 700 sq ft to 2000+ sq ft).

LPA observed the Clubhouse is the main building were management/maintenance offices are located. It also includes resident amenities such as the gardens, Bocce ball courts, Wood shop, Astronomy center, Dog parks, spa/salon, game/card rooms, billiard room, theater, fitness center, library, restaurant, cafe and dining rooms. Current census is 785 residents with total capacity for 828 residents. Fire Drill was last conducted in December of 2022. Emergency/Disaster Plan (LIC 610E) is posted near the reception desk and close to a Lan line phone.

LPA along with ADM inspected apartment units were clean and in good repair. There were grab bars in the bathrooms. Hot water temperatures were measured at 112.5 degrees Fahrenheit. Apartments have their own washer and dryer for use of the resident.

Report continue on LIC 809C...
SUPERVISOR'S NAME: Bennett FongTELEPHONE: (510) 725-7919
LICENSING EVALUATOR NAME: Kelly NguyenTELEPHONE: (510) 915-8702
LICENSING EVALUATOR SIGNATURE:
DATE: 12/14/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/14/2022
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1515 CLAY STREET, STE. 310
OAKLAND, CA 94612
FACILITY NAME: STONERIDGE CREEK PLEASANTON
FACILITY NUMBER: 019200474
VISIT DATE: 12/14/2022
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LPA observed each apartment has a kitchen. Units are equipped with refrigerators, dish washers, stove, washer and dryer. Life line emergency response buttons are in place in each bathroom. Each unit has also a check in button. Signal systems are either pendants that people wear or they can push a panic button. There is a check in button that people press first thing in the morning. If they do not check in, staff goes to check on them. Fire extinguishers (approx. 256) located throughout the facility's buildings were last inspected on 12/1/2022. The facility has a health services office where people may come if they aren't feeling well, need blood pressure taken, or minimal wound care for surgical wounds. There are 2 large dining rooms and kitchen. Kitchen freezer was observed at zero degrees Fahrenheit and three (3) refrigerators were at 35 degrees Fahrenheit. Food supply was checked and there is an adequate supply of 2 day perishables and 7 day non-perishables. Kitchen and food preparation areas were observed to be clean and in compliance.

LPA reviewed 18 staff files 18 out of 18 staffs have health clearance on files.

No deficiencies were observed in the areas that were evaluated. No citations were issued during today’s inspection. Exit interview conducted and a copy of this report provided to ADM.

SUPERVISOR'S NAME: Bennett FongTELEPHONE: (510) 725-7919
LICENSING EVALUATOR NAME: Kelly NguyenTELEPHONE: (510) 915-8702
LICENSING EVALUATOR SIGNATURE:

DATE: 12/14/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/14/2022
LIC809 (FAS) - (06/04)
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