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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 075600352
Report Date: 10/10/2023
Date Signed: 10/10/2023 04:58:49 PM


Document Has Been Signed on 10/10/2023 04:58 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:KELLI GREENEFACILITY TYPE:
740
ADDRESS:1400 MONTEGOTELEPHONE:
(925) 938-6611
CITY:WALNUT CREEKSTATE: CAZIP CODE:
94598
CAPACITY:200CENSUS: DATE:
10/10/2023
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
03:30 PM
MET WITH:Resident Services Director Stephanie Arabos and Executive Director Kelli GreeneTIME COMPLETED:
05:00 PM
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On 10/10/2023 at 3:30 PM, Licensing Program Analyst (LPA) J. Sampair arrived unannounced for a Case Management visit concerning the 5 Unusual Incident Reports of 5 unwitnessed falls occurring on the same day, 10/06/2023, two of which occurred to the same resident, R1. Upon arrival at the facility, the LPA stated the purpose of the visit to Resident Services Director (RSD) Stephanie Arabos and Executive Director (ED) Kelli Greene..

LPA Sampair interviewed RSD and ED about the incidents. Their explanation of all of the events indicated that they were following Title 22 regulation in serving their residents.

No citations issued during the visit.

Exit interview conducted and a copy of this report provided via email.
SUPERVISOR'S NAME: Bennett FongTELEPHONE: (510) -62-2621
LICENSING EVALUATOR NAME: James SampairTELEPHONE: (510) 286-4201
LICENSING EVALUATOR SIGNATURE:
DATE: 10/10/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/10/2023
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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