015600304-8-4-2022-15-AS-KHOS-CHCPWX-20220816114128

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 015600304
Report Date: 08/04/2022
Date Signed: 08/04/2022 01:34:51 PM

Unsubstantiated

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
05/21/2020 and conducted by Evaluator Laura Hall

COMPLAINT CONTROL NUMBER: 15-AS-20200521114907

FACILITY NAME:	QUAIL GARDEN		FACILITY NUMBER:	015600304
ADMINISTRATOR:	PEACOCK, ALICIA		FACILITY TYPE:	740
ADDRESS:	813 SOUTH J STREET		TELEPHONE:	(925) 449-4411
CITY:	LIVERMORE	STATE: CA	ZIP CODE:	94550
CAPACITY:	20	CENSUS: 17	DATE:	08/04/2022
		UNANNOUNCED	TIME BEGAN:	09:45 AM
MET WITH:	Kyle Cross, Caregiver		TIME COMPLETED:	12:55 PM

ALLEGATION(S):

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Staff are verbally abusive to residents

Staff are restricting phone time for residents

Staff are listening in on resident's phone calls

Staff are not responding to call button in a timely manner

INVESTIGATION FINDINGS:

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On 8/4/2022 at 09:45AM, Licensing Program Analysts (LPAs )L. Hall and C. Fowler arrived unannounced to conduct an complaint investigation and deliver complaint findings for the allegations above. LPA met with Caregiver, Kyle Cross and explained the reason for visit. Administrator, Alicia Peacock arrived at 10:05AM.

During the the course of the investigation LPA G. Luk interviewed S1. LPAs L. Hall and C. Fowler interviewed S1, three (3) residents, obtained and reviewed the following documents: facility roster, staff roster, incident reports., police reports, care notes, court document, and email to families.

Continued on LIC9099C.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Harpreet Humpal	TELEPHONE: (510) 285-3928
LICENSING EVALUATOR NAME: Laura Hall	TELEPHONE: (510) 622-2024
LICENSING EVALUATOR SIGNATURE:	DATE: 08/04/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/04/2022

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-20200521114907

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: QUAIL GARDEN	FACILITY NUMBER: 015600304
	VISIT DATE: 08/04/2022

NARRATIVE

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Continued from LIC9099.

On the allegation staff are verbally abusive to residents. LPAs L. Hall and C. Fowler interviewed three (3) of the residents. All three residents stated facility staff have never verbally abused them and they have never heard staff verbally abuse any resident.

On the allegation staff are restricting phone time for residents, S1 stated that the facility did restrict phone time for residents due to COVID. The facility tried to make sure that the residents that did not have a personal phone had time to speak with their family. The three (3) residents that were interviewed by LPAs all had their own personal phones. R2 stated that if her family was not able to reach her on her personal phone they would call the facility, staff would advise there is a personal phone call, and there was never a problem with using the facility's phone.

On the allegation staff are listening in on resident's phone calls. S1 stated that staff had to help R1 use the phone due to R1's cellular phone was a flip phone and did not have a speaker. If staff did not assist R1 with holding the phone, the phone would dropped. Therefore, staff could not help but to hear phone calls made to R1. Staff did not intentionally listen in on resident's phone call.

On the allegation staff is not responding to call button in a timely manner. S1 stated that a couple of times staff did not respond to R1 because R1 did not push the button correctly, therefore, the call system that is located at the front desk did not alarm. S1 stated the call button has to be pushed until it clicks. R2 stated her call button was lost, but is being replaced and sometimes at night it may take a while for staff to respond if doing laundry, but mostly there is a quick response. R2 also stated that staff checks on them regularly. R3 and R4 stated that when the call button is pushed staff comes right away. During investigation visit on today's date, LPA heard the call system alarming and observed staff following-up. S1 stated that there are call buttons they have been sent out to be repaired and replaced, but in the meantime there is a call button sitting near the bed.

Continued on LIC9099C.

SUPERVISOR'S NAME: Harpreet Humpal	TELEPHONE: (510) 285-3928
LICENSING EVALUATOR NAME: Laura Hall	TELEPHONE: (510) 622-2024
LICENSING EVALUATOR SIGNATURE:	DATE: 08/04/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/04/2022

LIC9099 (FAS) - (06/04)

Page: 2 of 3

Control Number 15-AS-20200521114907

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: QUAIL GARDEN	FACILITY NUMBER: 015600304
	VISIT DATE: 08/04/2022

NARRATIVE

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Continued from LIC9099C.

Based upon interviews and record review during investigation, the above allegations are unsubstantiated. A finding that the complaint is UNSUBSTANTIATED means that although the allegations may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violations occurred.

Exit interview conducted and a copy of this report provided.

SUPERVISOR'S NAME: Harpreet Humpal	TELEPHONE: (510) 285-3928
LICENSING EVALUATOR NAME: Laura Hall	TELEPHONE: (510) 622-2024
LICENSING EVALUATOR SIGNATURE:	DATE: 08/04/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/04/2022

LIC9099 (FAS) - (06/04)

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