011400514-2-22-2023-15-AS-YFLS-CPD2NP-20230224163306

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 011400514
Report Date: 02/16/2023
Date Signed: 02/22/2023 03:13:35 PM

Unfounded

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1515 CLAY STREET, STE. 310
OAKLAND, CA 94612

This is an official report of an unannounced visit/investigation of a complaint received in our office on
12/21/2021 and conducted by Evaluator Gregory Clark

COMPLAINT CONTROL NUMBER: 15-AS-20211221162034

FACILITY NAME:	PIEDMONT GARDENS #1		FACILITY NUMBER:	011400514
ADMINISTRATOR:	WITTMAN, DANIEL		FACILITY TYPE:	741
ADDRESS:	110-41ST STREET		TELEPHONE:	(510) 654-7172
CITY:	OAKLAND	STATE: CA	ZIP CODE:	94611
CAPACITY:	321	CENSUS: 280	DATE:	02/16/2023
		UNANNOUNCED	TIME BEGAN:	03:30 PM
MET WITH:	Jana Gesinger, Health Services Administrator		TIME COMPLETED:	04:10 PM

ALLEGATION(S):

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Unlawful Eviction

INVESTIGATION FINDINGS:

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**this is an amended report***On 2/22/23 at 3:00 p.m. , Licensing Program Analyst (LPA) Greg Clark arrived unannounced to deliver amended report for the above allegation and met with Jana Gesinger, Health Services Administrator and explained the purpose of the visit.

On 12/24/2021, LPA Alicia Delmundo conducted initial 10-day investigation, obtained records and interviewed Assisted Living (AL) Director Zinnia Koch. On 2/2/2023, this complaint was reassigned to LPA Luisa Fontanilla. On 2/3/2023, LPA Fontanilla interviewed AL Director Zinnia Koch.

Based on interviews conducted, AL Director denied evicting Resident 1 (R1). Director states there was no eviction letter issued to R1. R1 was sent out to the hospital on 12/15/2021. R1 was discharged back to the facility on 12/30/2021.

***report continues on LIC9099C***.

Unfounded

Estimated Days of Completion:

SUPERVISOR'S NAME: Yvonne Flores-Larios	TELEPHONE: (510) 286-0517
LICENSING EVALUATOR NAME: Gregory Clark	TELEPHONE: 510-285-3927
LICENSING EVALUATOR SIGNATURE:	DATE: 02/22/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/22/2023

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

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Control Number 15-AS-20211221162034

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1515 CLAY STREET, STE. 310
OAKLAND, CA 94612

FACILITY NAME: PIEDMONT GARDENS #1	FACILITY NUMBER: 011400514
	VISIT DATE: 02/16/2023

NARRATIVE

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*** report continues from LIC9099***

On 2/3/2023, 2/6/2023 and 2/7/2023, LPA Fontanilla contacted Witness 1 (W1) via telephone and email to obtain additional information . W1 was hired by R1’s family as R1’s Care Manager/Social Worker. On 2/7/2023, LPA received response from W1. W1 states that R1 was not evicted from the facility. W1 states that when R1 was hospitalized in December 2021, Piedmont Gardens was not able to accept R1 back to the facility until R1 was stabilized. And that the hospital was trying to discharge R1 back without R1 being stabilized.

Based on interviews conducted, the above allegation is unfounded.

This agency has investigated the complaint unlawful eviction. We have found that the complaint was unfounded, meaning that the allegation was false, could not have happened and/or is without reasonable basis. We have therefore dismissed the complaint.

There is no deficiency noted.

Exit interview was conducted and a copy of this report was provided.

SUPERVISOR'S NAME: Yvonne Flores-Larios	TELEPHONE: (510) 286-0517
LICENSING EVALUATOR NAME: Gregory Clark	TELEPHONE: 510-285-3927
LICENSING EVALUATOR SIGNATURE:	DATE: 02/16/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/16/2023

LIC9099 (FAS) - (06/04)

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