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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 079201351
Report Date: 05/03/2024
Date Signed: 05/03/2024 04:41:26 PM


Document Has Been Signed on 05/03/2024 04:41 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:BRIDGE VIEW SENIOR LIVINGFACILITY NUMBER:
079201351
ADMINISTRATOR:COSTELLO, JINGJING WANGFACILITY TYPE:
740
ADDRESS:390 EL DIVISADERO AVETELEPHONE:
(510) 612-2240
CITY:WALNUT CREEKSTATE: CAZIP CODE:
94598
CAPACITY:6CENSUS: 5DATE:
05/03/2024
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
11:00 AM
MET WITH:Applicant Jingjing Wang CostelloTIME COMPLETED:
05:00 PM
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On 05/03/2024 at 11:00 AM, Licensing Program Analysts (LPAs) J. Sampair and A. Gharachorloo arrived unannounced to conduct a change of ownership prelicensing visit. Upon entry into the facility, the LPAs informed Administrator Jingjing Wang Costello the purpose of the visit.

LPA toured the facility inside out with the ADM. The LPA inspected the kitchen, common areas, bedrooms, bathrooms, and the exterior of the facility. The facility was clean, appropriately furnished, and well lit. More than the 2 days of perishable and 7 days of nonperishable food supplies were available. No body of water was on the facility grounds. Medications are centrally stored. Personnel, client, and facility records stored at facility. Bathrooms and showers were observed to be fully functioning and clean. Carbon monoxide and smoke detectors operational and the fire extinguishers were last serviced on 02/22/2024. First aid kit inspected. Facility has emergency lighting.

Facility passed pre-licensing inspection and Component III training provided for ADM. Final review of application and license to be granted by Central Applications Bureau analyst.

Exit interview conducted and a copy of this report provided to the applicant.
SUPERVISOR'S NAME: Harpreet HumpalTELEPHONE: (510) 529-9416
LICENSING EVALUATOR NAME: James SampairTELEPHONE: (510) 286-4201
LICENSING EVALUATOR SIGNATURE:
DATE: 05/03/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/03/2024
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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