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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 075601498
Report Date: 02/15/2024
Date Signed: 02/15/2024 01:31:43 PM


Document Has Been Signed on 02/15/2024 01:31 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 IIFACILITY NUMBER:
075601498
ADMINISTRATOR:BRAGG, JILL L.FACILITY TYPE:
740
ADDRESS:15 GLEN CREEK LANETELEPHONE:
(925) 300-3821
CITY:WALNUT CREEKSTATE: CAZIP CODE:
94595
CAPACITY:6CENSUS: 6DATE:
02/15/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Licensee Jill BraggTIME COMPLETED:
02:00 PM
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On 02/15/2024 at 9:00 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.

LPA toured the interior and exterior of the facility. LPA inspected the kitchen, dining area, restrooms, community living spaces, bathrooms, resident rooms, and the grounds of the facility. More than the required minimum of 7 days of nonperishable and 2 days of perishable foods were appropriately stored. Temperature in the dining room was measured at 72.8 degrees Fahrenheit at 11:08 AM. Fire extinguisher was fully charged and last serviced on 9/9/2023. Carbon monoxide and smoke detectors were fully operational. The postings included a complaint poster, Ombudsman and Personal Rights posters, Theft and Loss Policy, Rights to Resident Council and Rights to Family Council were observed posted in a prominent location.

An administrator is on site more than the minimum of 20 hours a week to oversee the proper business operations. The LPA reviewed facility records, the records of 5 staff members, and the records for 6 residents, and interviewed interviewed 2 staff members and 2 residents.

No citations issued during inspection.

Exit interview conducted with Licensee. A copy of this report provided to the Licensee via email.
SUPERVISOR'S NAME: Bennett FongTELEPHONE: (510) -62-2621
LICENSING EVALUATOR NAME: James SampairTELEPHONE: (510) 286-4201
LICENSING EVALUATOR SIGNATURE:
DATE: 02/15/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/15/2024
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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