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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 079200326
Report Date: 07/03/2023
Date Signed: 07/03/2023 01:35:02 PM


Document Has Been Signed on 07/03/2023 01:35 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 PARK OF LAFAYETTEFACILITY NUMBER:
079200326
ADMINISTRATOR:QUINLAN-TUDDA, BARBARAFACILITY TYPE:
740
ADDRESS:1545 PLEASANT HILL RDTELEPHONE:
(925) 932-9910
CITY:LAFAYETTESTATE: CAZIP CODE:
94549
CAPACITY:130CENSUS: 86DATE:
07/03/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Barbara Tudda, Executive DirectorTIME COMPLETED:
02:00 PM
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On 07/03/23 at 10:00 AM, Licensing Program Analyst (LPA) L. Holmes conducted an unannounced required annual inspection. LPA met with Barbara Tudda, Executive Director (ED); Administrator Standard Certificate #6045021740 exp. 10/09/23.

LPA toured facility including but not limited to the common areas, courtyard, bathrooms, kitchens, medication room, theater, game room and Life Guidance (memory care unit). Hot water temperature in common area temperature was at a comfortable degrees; each resident has their own individual apartment. There are 2-days of non-perishables and 7-days of perishable food supplies. Facility food supplies are checked daily by chef and staff. Resident's medications were kept locked in the medication room. Smoke and carbon monoxide detectors are combined and observed throughout the facility and the bedrooms. First-aid kit was complete. Fire extinguisher was observed full and last inspected 05/28/23. No accessible bodies of water were observed. Indoor and outdoor passageways were free of obstruction. Emergency Disaster Plan (EDP) on file and following COVID-19 precautionary guidelines. Disaster drills completed very other month. Certificate of Liability Insurance exp. 06/01/24.

The following forms are to be updated and submitted to CCLD:
-LIC500 Personnel Report
-LIC308 Designation of Administrative Responsibility (Reviewed)
-LIC610C Emergency Disaster Plan (Reviewed)
ED to review resident and employee files and update forms.

No deficiencies cited on this date.
Exit interview conducted and a copy of this report provided to ED.
SUPERVISOR'S NAME: Yvonne Flores-LariosTELEPHONE: (510) 286-0517
LICENSING EVALUATOR NAME: Lisha HolmesTELEPHONE: 510-286-4201
LICENSING EVALUATOR SIGNATURE:
DATE: 07/03/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/03/2023
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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