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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 075601489
Report Date: 11/08/2023
Date Signed: 11/08/2023 01:43:15 PM


Document Has Been Signed on 11/08/2023 01:43 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:DIABLO ASSISTED LIVING IFACILITY NUMBER:
075601489
ADMINISTRATOR:BRAGG, JILL L.FACILITY TYPE:
740
ADDRESS:123 LOS CERROS AVENUETELEPHONE:
(925) 944-5363
CITY:WALNUT CREEKSTATE: CAZIP CODE:
94598
CAPACITY:6CENSUS: 6DATE:
11/08/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Jill BraggTIME COMPLETED:
02:00 PM
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On 11/08/23 at 9:00 AM, Licensing Program Analyst (LPA) J. Sampair performed an unannounced complaint visit. LPA met with staff persons S2 and S3 who were informed of the reason for the visit. Staff notified Licensee/Administrator Jill Bragg of the visit via telephone. She arrived at the facility at approximately 9:45 AM.

During the interview of Ms. Bragg, she stated that there was one family whom she had not informed of the painting, for which the LPA issued a Technical Advisory (refer to LIC9102).

No citations issued during the visit.

Exit interview conducted and a copy of this report provided via email.
SUPERVISOR'S NAME: Bennett FongTELEPHONE: (510) -62-2621
LICENSING EVALUATOR NAME: James SampairTELEPHONE: (510) 286-4201
LICENSING EVALUATOR SIGNATURE:
DATE: 11/08/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/08/2023
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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