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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 075600352
Report Date: 10/11/2023
Date Signed: 10/11/2023 06:08:37 PM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
OAKLAND ASC, 1515 CLAY STREET, STE. 310
OAKLAND, CA 94612
This is an official report of an unannounced visit/investigation of a complaint received in our office on
05/17/2023 and conducted by Evaluator James Sampair
COMPLAINT CONTROL NUMBER: 15-AS-20230517131516
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: 128DATE:
10/11/2023
UNANNOUNCEDTIME BEGAN:
04:00 PM
MET WITH:Executive Director Kelli GreeneTIME COMPLETED:
06:30 PM
ALLEGATION(S):
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Facility did not have a certified administrator.
Faciilty administrator was not qualified.
INVESTIGATION FINDINGS:
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On 10/11/2023 at 4:00 PM, Licensing Program Analyst (LPA) J. Sampair arrived at the facility unannounced to deliver findings for the allegations above. Upon entrance, LPA stated the purpose of the visit to Administrator (ADM) Kelli Greene.

At 5:10 PM, the LPA met with the ADM to deliver the findings.

Facility did not have a certified administrator.
Based on the records review of former Executive Director Jeffrey Freeth, he was a certified administrator.

Facility administrator was not qualified.
Based on the records review of former Executive Director Jeffrey Freeth, he was a qualified administrator.

(Continued on LIC9099-C...)
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Bennett FongTELEPHONE: (510) -62-2621
LICENSING EVALUATOR NAME: James SampairTELEPHONE: (510) 286-4201
LICENSING EVALUATOR SIGNATURE:

DATE: 10/11/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/11/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 1 of 2
Control Number 15-AS-20230517131516
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
OAKLAND ASC, 1515 CLAY STREET, STE. 310
OAKLAND, CA 94612
FACILITY NAME: ATRIA WALNUT CREEK
FACILITY NUMBER: 075600352
VISIT DATE: 10/11/2023
NARRATIVE
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(...Continued from LIC9099-C)

Although the allegations may have happened, or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegations are UNSUBSTANTIATED.

Exit interview was conducted with ADM. A copy of this report was provided via email.
SUPERVISOR'S NAME: Bennett FongTELEPHONE: (510) -62-2621
LICENSING EVALUATOR NAME: James SampairTELEPHONE: (510) 286-4201
LICENSING EVALUATOR SIGNATURE:

DATE: 10/11/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/11/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 2