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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 075600352
Report Date: 05/12/2023
Date Signed: 05/12/2023 10:19:37 AM


Document Has Been Signed on 05/12/2023 10:19 AM - 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:ATRIA WALNUT CREEKFACILITY NUMBER:
075600352
ADMINISTRATOR:KELLI GREENEFACILITY TYPE:
740
ADDRESS:1400 MONTEGOTELEPHONE:
(925) 938-6611
CITY:WALNUT CREEKSTATE: CAZIP CODE:
94598
CAPACITY:200CENSUS: 116DATE:
05/12/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
09:20 AM
MET WITH:Kelli Greene, Executive DirectorTIME COMPLETED:
10:25 AM
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On 5/12/2023 at 09:20AM, Licensing Program Analyst (LPA) L. Hall conducted an unannounced Case Management visit to follow-up on the accusation document that was provided to the facility. LPA met with Kelli Greene, Executive Director (ED) and explained the purpose of the visit.

LPA toured facility with ED and observed the facility posted written notice regarding the accusation. LPA also spoke with five (5) residents to confirm they have received written notice, all five (5) residents confirmed they did receive the notice. During visit LPA obtained the notice that was posted in the facility and the notice that was sent to the residents or their responsible party.

No deficiencies issued during the visit.

Exit interview conducted and a copy of this report was provided.
SUPERVISOR'S NAME: Harpreet HumpalTELEPHONE: (510) 285-3928
LICENSING EVALUATOR NAME: Laura HallTELEPHONE: (510) 622-2024
LICENSING EVALUATOR SIGNATURE:
DATE: 05/12/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/12/2023
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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