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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 075600353
Report Date: 01/09/2024
Date Signed: 01/09/2024 04:37:41 PM


Document Has Been Signed on 01/09/2024 04:37 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 VALLEY VIEWFACILITY NUMBER:
075600353
ADMINISTRATOR:KELLI L GREENEFACILITY TYPE:
740
ADDRESS:1228 ROSSMOOR PKWYTELEPHONE:
(925) 937-7300
CITY:WALNUT CREEKSTATE: CAZIP CODE:
94595
CAPACITY:153CENSUS: 104DATE:
01/09/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
03:05 PM
MET WITH:Executive Director Monique BindraTIME COMPLETED:
04:45 PM
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On 1/9/2024 at 3:05 PM, Licensing Program Analyst (LPA) J. Sampair arrived unannounced to pick up documents requested during 1/8/2024 complaint inspection and to complete the health and safety check of the facility begun 1/8/2024. Upon arrival, LPA stated the purpose of the visit to Executive Director (ED) Monique Bindra.

LPA got the documents requested from Resident Services Director Joanne Bustos.

LPA confirmed inspections of the facility's fire protection systems last completed April of 2023 with Maintenance Director Kaila Homolka.

No citations issued.

Exit interview conducted and a copy of this report provided to ED via email.
SUPERVISOR'S NAME: Bennett FongTELEPHONE: (510) -62-2621
LICENSING EVALUATOR NAME: James SampairTELEPHONE: (510) 286-4201
LICENSING EVALUATOR SIGNATURE:
DATE: 01/09/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/09/2024
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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