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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 079201351
Report Date: 09/23/2024
Date Signed: 09/23/2024 03:01:14 PM


Document Has Been Signed on 09/23/2024 03:01 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: 6DATE:
09/23/2024
TYPE OF VISIT:Post LicensingUNANNOUNCEDTIME BEGAN:
10:30 AM
MET WITH:Jingjing CostelloTIME COMPLETED:
03:30 PM
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On 9/232024 at 10:30 AM, Licensing Program Analysts (LPA) James Sampair arrived unannounced to conduct the Post-Licensing Inspection. Upon entry, the LPA stated the purpose of the visit to Caregiver Precilla Cabrera. Administrator Jingjing Costello arrived at approximately 11:30 AM.

The LPA inspected the interior and exterior of the facility, including the kitchen, dining area, restrooms, community living spaces, resident rooms, storage areas, and the grounds of the facility. More than the required minimum of 7 days of nonperishable and 2 days of perishable foods were appropriately stored.

Temperature in the dining room was measured at 75.3 degrees Fahrenheit at 2:37 PM. The fire extinguishers were fully charged and last replaced on 02/22/2024.

The carbon monoxide and smoke detectors were fully operational. The LPA observed postings in the facility that included a complaint poster, Ombudsman and Personal Rights posters, Theft and Loss Policy, Rights to Resident Council, and Rights to Family Council.

An administrator is on site more than the minimum of 20 hours a week to oversee the proper business operations. The LPA reviewed facility records, records of 5 staff members, and records of 5 residents. The LPA interviewed 1 resident and 2 staff members.

No citation was issued.

Exit interview conducted and a copy of this report provided.
SUPERVISOR'S NAME: Harpreet HumpalTELEPHONE: (510) 529-9416
LICENSING EVALUATOR NAME: James SampairTELEPHONE: (510) 286-4201
LICENSING EVALUATOR SIGNATURE:
DATE: 09/23/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/23/2024
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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