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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 019200474
Report Date: 07/10/2024
Date Signed: 07/10/2024 10:55:25 AM


Document Has Been Signed on 07/10/2024 10:55 AM - 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:STONERIDGE CREEK PLEASANTONFACILITY NUMBER:
019200474
ADMINISTRATOR:EZEKIEL GRIFFINFACILITY TYPE:
741
ADDRESS:3300 STONERIDGE CREEK WAYTELEPHONE:
(925) 201-4000
CITY:PLEASANTONSTATE: CAZIP CODE:
94588
CAPACITY:828CENSUS: 780DATE:
07/10/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Ezekiel Griffin, Executive DirectorTIME COMPLETED:
11:00 AM
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On 7/10/2024 at 10:00am, Licensing Program Analysts (LPAs) L. Hall and Ardalan Gharachorloo conducted an unannounced Case Management visit regarding an incident that was reported to CCLD on 7/8/2024. LPAs met with Ezekiel Griffin, Executive Director, and explained the purpose of the visit.

The incident reported involved an independent resident being financially abused by an unknown individual. Executive Director stated the facility was unaware of the incident until July 5th, 2024; however, the abuse had been going on for sometime. Executive Director stated at this time there is no concern regarding the resident's well-being.

No deficiencies issued during the visit.

Exit interview conducted and a copy of this report was provided.
SUPERVISOR'S NAME: Harpreet HumpalTELEPHONE: (510) 285-3928
LICENSING EVALUATOR NAME: Laura HallTELEPHONE: (510) 622-2024
LICENSING EVALUATOR SIGNATURE:
DATE: 07/10/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/10/2024
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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