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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 079200326
Report Date: 06/19/2024
Date Signed: 06/19/2024 01:31:26 PM


Document Has Been Signed on 06/19/2024 01:31 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: 91DATE:
06/19/2024
TYPE OF VISIT:Case Management - Health ChecksUNANNOUNCEDTIME BEGAN:
11:45 AM
MET WITH:Kawana Anthony, Operations Specialist TIME COMPLETED:
01:45 PM
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On 06/19/2024 at 11:45 AM, Licensing Program Analyst (LPA) J. Clancy-Czuleger conducted an unannounced Health & Safety inspection. LPA met with Operations Specialist, Kawana Anthony.

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. No accessible bodies of water were observed. Indoor and outdoor passageways were free of obstruction.

No deficiencies are cited on this date.

Exit interview conducted. A copy of this report provided to ED.
SUPERVISOR'S NAME: Harpreet HumpalTELEPHONE: (510) 285-3928
LICENSING EVALUATOR NAME: Jill Clancy-CzulegerTELEPHONE: 510-286-4201
LICENSING EVALUATOR SIGNATURE:
DATE: 06/19/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/19/2024
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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