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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 075600352
Report Date: 11/19/2024
Date Signed: 11/19/2024 01:49:33 PM

Document Has Been Signed on 11/19/2024 01:49 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:ATRIA WALNUT CREEKFACILITY NUMBER:
075600352
ADMINISTRATOR/
DIRECTOR:		KELLI GREENEFACILITY TYPE:
740
ADDRESS:1400 MONTEGOTELEPHONE:
(925) 938-6611
CITY:WALNUT CREEKSTATE: CAZIP CODE:
94598
CAPACITY: 200CENSUS: 150DATE:
11/19/2024
TYPE OF VISIT:Case Management - Legal/Non-complianceUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
12:45 PM
MET WITH:Community Business Director Jobelle DungcaTIME VISIT/
INSPECTION COMPLETED:
03:00 PM
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On 11/19/2024 at 12:45 PM, Licensing Program Analyst (LPA) James Sampair arrived unannounced to conduct the quarterly inspection of the facility to ensure that the requirements of the 11/29/2023 stipulation are being followed. Upon arrival, LPA stated the purpose of the visit to Community Business Director (CBD) Jobelle Dungca.

During this visit, the LPA observed: (1) stipulation posted in a conspicuous place, (2) kitchen and dining area signage posted that no food or beverage containers shall be used for any other purpose than food or beverage containment, and (3) Life Guidance was staffed within the required ratios from the stipulation: 5 direct caregivers completing only direct caregiving tasks for the 36 residents (within the required 1 staff to 8 resident ratio for day and afternoon/evening shifts) and 4 overnight staff for the 36 residents completing only direct caregiving tasks (within the required 1 staff to 10 resident ratio).

The CBD and LPA reviewed documents pertaining to the stipulation requirements. The LPA verified that every new resident and/or responsible party had acknowledged receipt of a copy of the stipulation. The LPA verified that a Hazardous Materials and Policies and Procedures Manual was available to all staff at the front desk. The fourth quarterly audit was completed 9/19/2024 and an audit report was provided to the Department on 10/14/2024.

No citations issued during visit.

Exit interview conducted and a copy of this report provided.
SUPERVISORS NAME: Harpreet Humpal
LICENSING EVALUATOR NAME: James Sampair
LICENSING EVALUATOR SIGNATURE: DATE: 11/19/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/19/2024
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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