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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 079201006
Report Date: 12/01/2021
Date Signed: 12/01/2021 05:28:07 PM

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:VIAMONTE AT WALNUT CREEKFACILITY NUMBER:
079201006
ADMINISTRATOR:MITCHELL, MELODYFACILITY TYPE:
741
ADDRESS:2801 SHADELANDS DRIVETELEPHONE:
(925) 954-2621
CITY:WALNUT CREEKSTATE: CAZIP CODE:
94598
CAPACITY:300CENSUS: 126DATE:
12/01/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
01:18 PM
MET WITH:Melody Mitchell and Micheal CalhounTIME COMPLETED:
05:49 PM
NARRATIVE
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Licensing Program Analyst (LPA) James Sampair conducted a required infection control annual inspection. Upon arrival, LPA explained the purpose of the visit to Executive Director Melody Mitchell, who led, along with Director of Environmental Services Micheal Calhoun, a tour of the facility inside and outside. The facility has a completed COVID-19 mitigation plan (LIC 808). The LPA observed that a digital system is being used for Covid-19 screening of all visitors and staff. LPA observed all staff wearing face masks during visit.

There were Covid-19 signs at the entry point for visitors, but signs were not posted throughout facility to promote handwashing, cough/sneeze etiquette, physical distancing, or mask wearing for residents for which they were provided Technical Assistance, because this practice has a health and safety impact that includes, but is not limited to buildings and grounds, personnel requirements, and personal rights.

There were sufficient food and water supplies and PPE supplies. The temperature within the facility was maintained at a comfortable level. A certified administrator is on site more than the minimum of 20 hours a week to oversee proper business operation. There were two Type A violations:
  • 2:19PM hot water temperature in Third Floor Model Room measured at 122 degrees F
  • 2:31PM cleaning solution in Aspen Room in unlocked cabinet under sink

An exit interview conducted and a copy of this report was provided to the administrator.
SUPERVISOR'S NAME: Harpreet HumpalTELEPHONE: (510) 285-3928
LICENSING EVALUATOR NAME: James SampairTELEPHONE: (510) 286-4201
LICENSING EVALUATOR SIGNATURE:

DATE: 12/01/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/01/2021
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC809 (FAS) - (06/04)
Page: 1 of 3
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1515 CLAY STREET, STE. 310
OAKLAND, CA 94612

FACILITY NAME: VIAMONTE AT WALNUT CREEK
FACILITY NUMBER: 079201006
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/01/2021

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
CCR
87303(e)(2)
Maintenance and Operation
(e) Water supplies and plumbing fixtures shall be maintained as follows: (2) Faucets used by residents for personal care such as shaving and grooming shall deliver hot water. Hot water temperature controls shall be maintained to automatically regulate the temperature of hot water used by residents to attain a temperature of not less than 105 degree F (41 degrees C) and not more than 120 degree F (49 degrees C).

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, the licensee did not comply with the section cited above when at 2:19PM the hot water temperature in Third Floor Model Room (indicative of hot water temperature throughout the facility) was measured at 122 degrees F by LPA, which poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date: 12/02/2021
Plan of Correction
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Attestation by a manager must be sent to LPA that facility hot water temperature has been lowered to the safe range of 105 and 120 degree F.
Type A
Section Cited
CCR
87309(a)
Storage Space
(a) Disinfectants, cleaning solutions, poisons, firearms and other items which could pose a danger if readily available to clients shall be stored where inaccessible to clients.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, the licensee did not comply with the section cited above when LPA observed in Aspen Lounge at 2:31PM that a cleaning solution was in unlocked cabinet under the sink, which poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date: 12/02/2021
Plan of Correction
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Attestation by a manager must be sent to LPA that ALL cabinets have been checked thoroughly in facility where memory care and assisted living residents live and that any cleaning solutions or other possibly injurious items (including sharp objects) have been removed from those locations. Further, plans for staff training within one week on safeguarding residents from such possibly injurious items must also be sent to LPA.
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME: Harpreet HumpalTELEPHONE: (510) 285-3928
LICENSING EVALUATOR NAME: James SampairTELEPHONE: (510) 286-4201
LICENSING EVALUATOR SIGNATURE:
DATE: 12/01/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/01/2021
LIC809 (FAS) - (06/04)
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