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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 079201006
Report Date: 10/17/2024
Date Signed: 10/17/2024 04:55:39 PM

Document Has Been Signed on 10/17/2024 04:55 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:VIAMONTE AT WALNUT CREEKFACILITY NUMBER:
079201006
ADMINISTRATOR/
DIRECTOR:		MELODY MITCHELL ALLENFACILITY TYPE:
741
ADDRESS:2801 SHADELANDS DRIVETELEPHONE:
(925) 954-2600
CITY:WALNUT CREEKSTATE: CAZIP CODE:
94598
CAPACITY: 300CENSUS: 270DATE:
10/17/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:15 PM
MET WITH:Wellness Director Christine JeanTIME VISIT/
INSPECTION COMPLETED:
05:15 PM
NARRATIVE
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On 10/17/2024 at 1:15 PM, Licensing Program Analysts (LPAs) James Sampair and David Doidge arrived unannounced to conduct the Required Annual Inspection of the facility. Upon arrival, LPAs stated the purpose of the visit to Wellness Director Christine Jean.

The LPAs toured the third floor of the facility. Sharps and dangerous items were inaccessible to clients. Client rooms were observed to be cleaned and fully furnished. Indoor passages were free of obstruction. Fire extinguishers were observed to be full and last serviced on 7/9/2024. Temperature in the facility was measured at 70.1 degrees Fahrenheit at 4:30 PM. The hot water temperature in Room 348 was measured at 124.7 degrees Fahrenheit at 4:09 PM.

The LPAs reviewed the records of 10 clients. The LPAs interviewed 2 staff members.

1 Type-A citation was issued.

The annual inspection is incomplete. The LPA will return unannounced at a future date and time to complete the annual inspection.

Exit interview conducted and a copy of this report provided.
SUPERVISORS NAME: Harpreet Humpal
LICENSING EVALUATOR NAME: James Sampair
LICENSING EVALUATOR SIGNATURE: DATE: 10/17/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/17/2024
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 2
Document Has Been Signed on 10/17/2024 04:55 PM - It Cannot Be Edited


Created By: James Sampair On 10/17/2024 at 04:43 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

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

FACILITY NAME: VIAMONTE AT WALNUT CREEK
FACILITY NUMBER: 079201006

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/17/2024

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 where the hot water temperature in room 348 was measured at 124.7 degrees Farenheit at 4:09 PM, which poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date: 10/18/2024
Plan of Correction
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On or before due date, the Licensee shall inform LPA Sampair that the temperature in that room has been reduced to between 105 and 120 degrees Farenheit.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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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 Humpal
LICENSING EVALUATOR NAME:James Sampair
LICENSING EVALUATOR SIGNATURE:
DATE: 10/17/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/17/2024


LIC809 (FAS) - (06/04)
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