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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 075600352
Report Date: 06/29/2023
Date Signed: 06/29/2023 06:04:56 PM

Document Has Been Signed on 06/29/2023 06:04 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
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: 122DATE:
06/29/2023
TYPE OF VISIT:Case Management - Annual ContinuationUNANNOUNCEDTIME BEGAN:
02:15 PM
MET WITH:Administrator Kelli GreeneTIME COMPLETED:
06:15 PM
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On 06/29/2023 at 02:15 PM, Licensing Program Analyst (LPA) J. Sampair arrived unannounced to conduct a continuation of the Annual Inspection that began on 06/21/2023. Upon entry, LPA stated the purpose of the visit to Administrator (ADM) Kelli Greene.

LPA and ADM toured the facility together. During the inspection, LPA reviewed files of 5 residents and 5 staff, toured the facility inside and outside, and interviewed 5 residents and 4 staff members.

During this inspection, no citations were issued.

Exit interview conducted with ADM and a copy of this report was provided via email.
SUPERVISORS NAME: Harpreet Humpal
LICENSING EVALUATOR NAME: James Sampair
LICENSING EVALUATOR SIGNATURE: DATE: 06/29/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/29/2023
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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