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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 019200521
Report Date: 12/27/2024
Date Signed: 12/27/2024 03:35:06 PM

Document Has Been Signed on 12/27/2024 03:35 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:CREEKVIEW ASSISTED LIVINGFACILITY NUMBER:
019200521
ADMINISTRATOR/
DIRECTOR:		PATRICK D. MCELROYFACILITY TYPE:
740
ADDRESS:2900 STONERIDGE DRIVETELEPHONE:
(925) 353-5717
CITY:PLEASANTONSTATE: CAZIP CODE:
94588
CAPACITY: 136CENSUS: 67DATE:
12/27/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
11:15 AM
MET WITH:Administrator, Patrick McElroyTIME VISIT/
INSPECTION COMPLETED:
04:10 PM
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On 12/27/2024 at 11:15 AM, Licensing Program Analyst (LPA) Ardalan Gharachorloo arrived unannounced to conduct 1-Year Annual Required inspection. At 12:51 PM, LPA met with administrator,Patrick McElroy and explained the purpose of the visit.

LPA toured the facility with the Administrator including but not limited to 5 residents’ apartments, bathrooms, multiple activity rooms, kitchen, common area and courtyard. There are no bodies of water observed. LPA observe lighting in all rooms are adequate for the comfort and safety of the residents. Hallway temperature was maintained at 75 degrees F. The hot water temperature in a residents’ shared bathroom was measured at 114 degrees Fahrenheit. Residents’ bathrooms are equipped with grab bars and non-skid mats. There is a minimum of one week supply of nonperishable and 2-day of perishable foods. Centrally stored medications, sharps and toxic are locked and inaccessible to residents in care.

Smoke detectors and carbon monoxide detectors were in operating condition during visit. Fire extinguisher was last serviced on 12/02/2024. Emergency Disaster Plan was last reviewed and posted on 08/08/2024. First aid kit was observed to be complete. Emergency disaster drill was last conducted on 12/11/2024.

LPA reviewed 6 residents records and 6 staff records, and all were complete. LPA also reviewed a sample of resident’s medications.

LPA requested and reviewed the following documents: LIC 500 Personnel Report, LIC 610E Emergency Disaster Plan, Liability Insurance ,and Current Administrator’s Certificate.

No deficiencies cited during visit. Exit interview conducted and a copy of this report provided.
SUPERVISORS NAME: Yvonne Flores-Larios
LICENSING EVALUATOR NAME: Ardalan Gharachorloo
LICENSING EVALUATOR SIGNATURE: DATE: 12/27/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/27/2024
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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