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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 075600352
Report Date: 12/04/2023
Date Signed: 12/04/2023 04:15:33 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
12/01/2023 and conducted by Evaluator James Sampair
PUBLIC
COMPLAINT CONTROL NUMBER: 15-AS-20231201092619
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: 135DATE:
12/04/2023
UNANNOUNCEDTIME BEGAN:
01:24 PM
MET WITH:Executive Director (ED) Kelli GreeneTIME COMPLETED:
04:29 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Staff do not ensure a comfortable living environment for residents
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
On 12/04/2023 at 1:24 PM, Licensing Program Analyst (LPA) J. Sampair performed an unannounced complaint visit pertaining to the allegation above. The LPA informed the Executive Director (ED) Kelli Greene of the purpose of the visit upon entry.

The complaint alleges that staff do not ensure a comfortable living environment for residents due to the noises of Resident 2 (R2)'s pet. At 1:29 PM, the ED stated, and a review of the records confirmed, that R2's Responsible Party, Witness 1 (W1), did not disclose having a pet at lease signing and that it was brought to R2's room without notification. The ED has been actively working with W1 to remove the pet since first notification of the disturbance on 11/21/2023.

Although the allegation may have happened, or is valid, there is not a preponderance of evidence to prove that staff do not ensure a comfortable living environment for residents. Therefore, the allegation is UNSUBSTANTIATED.

Exit interview conducted with the ED and a copy of this report was provided via email.
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: 12/04/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/04/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
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