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

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 075601489
Report Date: 02/13/2024
Date Signed: 02/13/2024 02:17:07 PM


Document Has Been Signed on 02/13/2024 02:17 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:DIABLO ASSISTED LIVING IFACILITY NUMBER:
075601489
ADMINISTRATOR:BRAGG, JILL L.FACILITY TYPE:
740
ADDRESS:123 LOS CERROS AVENUETELEPHONE:
(925) 944-5363
CITY:WALNUT CREEKSTATE: CAZIP CODE:
94598
CAPACITY:6CENSUS: 5DATE:
02/13/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:45 AM
MET WITH:Licensee Jill BraggTIME COMPLETED:
02:30 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
On 02/13/2024 at 10:45 AM, Licensing Program Analyst (LPA) James Sampair arrived unannounced to conduct a required annual inspection. LPA explained the purpose of the visit to Licensee Jill Bragg.

The LPA inspected facility inside and out. LPA reviewed files of 5 residents and 5 staff members. There were at least 7 days of nonperishable and 2 days of perishable foods. Temperature in the facility at 12:47 PM was measured at 72.8 degrees in the dining room. Fire extinguisher was fully charged and serviced on 9/24/2023. Carbon monoxide and smoke detectors were fully operational. An administrator is on site more than the minimum of 20 hours a week to oversee the proper business operations.

No citations issued during inspection.

Exit interview conducted with Annie Honrubia and a copy of this report provided via email to Licensee.
SUPERVISOR'S NAME: Bennett FongTELEPHONE: (510) -62-2621
LICENSING EVALUATOR NAME: James SampairTELEPHONE: (510) 286-4201
LICENSING EVALUATOR SIGNATURE:
DATE: 02/13/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/13/2024
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