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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 075600352
Report Date: 04/30/2024
Date Signed: 04/30/2024 02:28:23 PM

Document Has Been Signed on 04/30/2024 02:28 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
OAKLAND ASC, 1515 CLAY STREET, STE. 310
OAKLAND, CA 94612
FACILITY NAME:ATRIA WALNUT CREEKFACILITY NUMBER:
075600352
ADMINISTRATOR/
DIRECTOR:		KELLI GREENEFACILITY TYPE:
740
ADDRESS:1400 MONTEGOTELEPHONE:
(925) 938-6611
CITY:WALNUT CREEKSTATE: CAZIP CODE:
94598
CAPACITY: 200CENSUS: 133DATE:
04/30/2024
TYPE OF VISIT:Case Management - Annual ContinuationUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:00 AM
MET WITH:Executive Director Kelli GreeneTIME VISIT/
INSPECTION COMPLETED:
02:45 PM
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On 4/29/2024 at 9:00 AM, Licensing Program Analysts (LPAs) J. Sampair and A. Gharachorloo arrived unannounced to continue the Required Annual Inspection of the facility that began 4/24/2024. Upon arrival, the LPAs stated the purpose of the visit to Executive Director (ED) Kelli Greene.

The LPA, ED, and Compliance Director Patricia Hoguin examined the emergency food and water supplies. The LPAs verified the completion of required staff training and the completion of quarterly emergency/disaster training for staff during every shift. The LPAs reviewed 7 resident and 5 staff files and interviewed 5 staff and 5 residents.

The annual inspection is complete.

No citations issued during the inspection.

Exit interview conducted and a copy of this report provided.
Harpreet Humpal
James Sampair
DATE: 04/30/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/30/2024
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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