<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 415600133
Report Date: 01/26/2024
Date Signed: 02/14/2024 09:22:33 AM


Document Has Been Signed on 02/14/2024 09:22 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
SF COASTAL AC/SC, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066



FACILITY NAME:ATRIA PARK OF SAN MATEOFACILITY NUMBER:
415600133
ADMINISTRATOR:KRIS WALUSZKOFACILITY TYPE:
740
ADDRESS:2883 S NORFOLK STTELEPHONE:
(650) 378-3000
CITY:SAN MATEOSTATE: CAZIP CODE:
94403
CAPACITY:175CENSUS: DATE:
01/26/2024
TYPE OF VISIT:OfficeUNANNOUNCEDTIME BEGAN:
02:00 PM
MET WITH:Kris Waluszko and Kirk Brooks
TIME COMPLETED:
03:00 PM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
The San Bruno and Oakland CCLD Adult & Senior Care Regional Offices, and CCLD Counsel, conducted a collaborative virtual meeting with representatives for Atria Park of San Mateo (San Bruno Region) and Atria Walnut Creek (Oakland Region) to review the Stipulation Agreements for both facilities, dated 11/29/2023. CCLD Staff Attorney, Lisa Wiggins, discussed the stipulations and their status implementation; and questions and clarifications were addressed.

Meeting Participants:

Lisa Wiggins – Counsel, CCLD
Vivien Helbling – Regional Manager, CCLD, San Bruno ASC
Isaac Taggart – Regional Manager, CCLD, Oakland ASC
Cara Smith – Licensing Program Manager, CCLD, San Bruno ASC
April Cowan – Licensing Program Manager, CCLD, San Bruno ASC
Jeremy Fong – Licensing Program Manager, CCLD, Oakland ASC
Audrey Jeung – Licensing Program Analyst, CCLD, San Bruno ASC
James Sampair – Licensing Program Analyst, CCLD, Oakland ASC
Aron Alexander – Regional Vice President, Atria Senior Living
Kris Waluszko – Regional Vice President, Atria Senior Living
Jay Thomas – Counsel, Atria Senior Living
Kirk Brooks – National Operations Specialist, Atria Senior Living
Kelli Greene – Executive Director, Atria of Walnut Creek
Patricia Holguin – Compliance Director, Atria Senior Living

This report was emailed to Atria representative for signature, to be returned to San Bruno ASC regional office.
SUPERVISOR'S NAME: Cara SmithTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Audrey JeungTELEPHONE: (650) 266-8891
LICENSING EVALUATOR SIGNATURE:
DATE: 01/26/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/26/2024
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 1