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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 019200521
Report Date: 01/18/2024
Date Signed: 01/18/2024 04:19:53 PM


Document Has Been Signed on 01/18/2024 04:19 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
CCLD Regional Office, 1515 CLAY STREET, STE. 310
OAKLAND, CA 94612



FACILITY NAME:CREEKVIEW ASSISTED LIVINGFACILITY NUMBER:
019200521
ADMINISTRATOR:PATRICK D. MCELROYFACILITY TYPE:
740
ADDRESS:2900 STONERIDGE DRIVETELEPHONE:
(925) 353-5717
CITY:PLEASANTONSTATE: CAZIP CODE:
94588
CAPACITY:136CENSUS: 69DATE:
01/18/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Vivian Wong, Assited Living Director TIME COMPLETED:
04:45 PM
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Licensing Program Analyst (LPA) K. Nguyen conducted an unannounced 1-year Required inspection on 01/18/2024 at 10:00am. LPA met with Assisted Living Director, Vivian Wong and explained the purpose of the visit. Administrator Patrick was not available at the time.

LPA toured the facility with Assisted Living Manger including but not limited to apartments, bathrooms, kitchen, multiple activity rooms, common area and courtyard. All outdoor and indoor passageways are kept free of obstruction. There are no bodies of water observed. A comfortable temperature is maintained at 72 degrees in random apartment LPA observed lighting in all rooms are adequate for the comfort and safety of the residents. A sample of hot water temperature in the resident’s apartment were measured at 107-, 115-, and 110-degrees Fahrenheit. Residents’ bathrooms are equipped with grab bars and non-skid mats. There is a minimum of 7-day supply of non-perishable and 2-day of perishable foods. Emergency supplies were observed.

Smoke detectors, sprinkler system and carbon monoxide were observed throughout facility. Fire alarm testing was completed on 12/12/23. Fire extinguisher was last serviced on 2/5/2023. Emergency Disaster Plan was last posted on 10/2023. Fire drill was last conducted on 10/19/2023.

LPA reviewed 8 residents records. LPA reviewed a sample of 6 staff record files and observed 6 of 6 have health screening with TB test result on file. The facility has sufficient staffing to provide the services needed to meet the residents’ needs.

No deficiencies cited during visit. Exit interview conducted and a copy of this report provided.
SUPERVISOR'S NAME: Bennett FongTELEPHONE: (510) 725-7919
LICENSING EVALUATOR NAME: Kelly NguyenTELEPHONE: (510) 915-8702
LICENSING EVALUATOR SIGNATURE:
DATE: 01/18/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/18/2024
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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