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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 075600353
Report Date: 01/26/2023
Date Signed: 01/26/2023 12:51:20 PM


Document Has Been Signed on 01/26/2023 12:51 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 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: 95DATE:
01/26/2023
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
10:15 AM
MET WITH:Kelli GreeneTIME COMPLETED:
01:15 PM
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On 01/26/2023 at 10:15 AM, Licensing Program Analyst (LPA) J. Sampair arrived unannounced to conduct a Case Management visit that concerned an Unusual Incident Report (UIR) that described an incident on 01/18/2023. The UIR concerned a supposed verbal threat made to resident R1 by R2 on 01/18/2023. R2 did not remember having had that exchange with R1 and there were no witnesses of it having occurred.

Upon entry, LPA explained the purpose of the visit to Rosario Holandez, Community Business Director. Executive Director (ED) Kelli Greene arrived at approximately 10:45 AM. During the meeting, the LPA and ED reviewed both residents' records and what actions had been taken up to this time and the future actions to be taken to reduce the likelihood of additional conflicts between the residents.

The LPA was satisfied that the facility was taking the appropriate measures.

No citations were issued.

Exit interview conducted and copy of this report provided via email.
SUPERVISOR'S NAME: Harpreet HumpalTELEPHONE: (510) 285-3928
LICENSING EVALUATOR NAME: James SampairTELEPHONE: (510) 286-4201
LICENSING EVALUATOR SIGNATURE:
DATE: 01/26/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/26/2023
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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