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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 02:25:46 PM


Document Has Been Signed on 04/30/2024 02:25 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: 133DATE:
04/30/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Executive Director Kelli GreeneTIME COMPLETED:
02:45 PM
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On 4/30/2024 at 9:00 AM, Licensing Program Analyst (LPAs) J. Sampair and A. Gharachorloo arrived unannounced to conduct the quarterly inspection of the facility to ensure that the requirements of the 11/29/2023 stipulation are being followed. Upon arrival, LPAs stated the purpose of the visit to Executive Director (ED) Kelli Greene, and Compliance Director Patricia Hoguin.

During this visit and when LPA Sampair was at the facility on 4/24/2024, the LPAs observed: (1) stipulation posted in a conspicuous place, (2) kitchen and dining area signage posted that no food or beverage containers shall be used for any other purpose than food or beverage containment, and (3) Life Guidance was staffed within the required ratios from the stipulation: 5 direct caregivers completing only direct caregiving tasks for the 32 residents (within the required 1 staff to 8 resident ratio for day and afternoon/evening shifts) and 4 overnight staff for the 32 residents completing only direct caregiving tasks (within the required 1 staff to 10 resident ratio).

The ED, Compliance Director Patricia Hoguin, and LPAs reviewed documents pertaining to the stipulation requirements. The LPAs verified that every new resident and/or responsible party had acknowledged receipt of a copy of the stipulation. The LPAs verified that a Hazardous Materials and Policies and Procedures Manual was available to all staff at the front desk. The second quarterly audit was completed 3/6/2024 and an audit report was provided to the Department within 14 days, on 3/13/2024.

No citations issued during visit.

Exit interview conducted and a copy of this report provided to ED.
SUPERVISOR'S NAME: Harpreet HumpalTELEPHONE: (510) 529-9416
LICENSING EVALUATOR NAME: James SampairTELEPHONE: (510) 286-4201
LICENSING EVALUATOR SIGNATURE:
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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