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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 015601095
Report Date: 12/27/2024
Date Signed: 12/27/2024 05:51:02 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
02/13/2024 and conducted by Evaluator Grace Luk
PUBLIC
COMPLAINT CONTROL NUMBER: 15-AS-20240213095509
FACILITY NAME:HERITAGE ESTATESFACILITY NUMBER:
015601095
ADMINISTRATOR:SUSAN DONAGHYFACILITY TYPE:
740
ADDRESS:900 E STANLEY BLVDTELEPHONE:
(925) 373-3636
CITY:LIVERMORESTATE: CAZIP CODE:
94550
CAPACITY:65CENSUS: 59DATE:
12/27/2024
UNANNOUNCEDTIME BEGAN:
12:30 PM
MET WITH:Michael Fillari, General ManagerTIME COMPLETED:
05:00 PM
ALLEGATION(S):
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Facility is not able to meet the needs of the resident.
Staff member threatens resident in care.
Staff member prohibits resident from seeking medical attention when needed.
Facility does not have enough staff to meet the needs of resident in care.
INVESTIGATION FINDINGS:
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On 12/27/2024 at 12:30PM, Licensing Program Analyst (LPA) G. Luk arrived unannounced to conduct complaint investigation and to deliver complaint findings for the allegations above. LPA met with General Manager, Michael Fillari and explained the purpose of the visit.

During the investigation, LPA interviewed 4 residents, 5 staff, and witness. LPA reviewed and obtained documents including staff schedule, emergency information, physician's report, care plan, care notes, incident reports, and call button logs.

Facility is not able to meet the needs of the resident.
After reviewing R2's physician's report and care plan, the physician's report stated that R2 is capable of self-care for bathing, toileting, grooming, dressing, and feeding. R2's care plan states that R2 is independent for toileting, dressing, grooming, and transfers. However, care notes have revealed that R2 was assisted with transfers when needed. (Continue on LIC9099C...)
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Harpreet Humpal
LICENSING EVALUATOR NAME: Grace Luk
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.
LIC9099 (FAS) - (06/04)
Page: 1 of 2
Control Number 15-AS-20240213095509
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: HERITAGE ESTATES
FACILITY NUMBER: 015601095
VISIT DATE: 12/27/2024
NARRATIVE
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Staff member threatens resident in care.
Interview with staff and residents revealed that staff have not threaten residents. Residents stated that staff are friendly to residents.

Staff member prohibits resident from seeking medical attention when needed.
Interview with staff indicated that residents have access to a phone, pendent, and pull cord to get assistance or medical attention. Interview with residents revealed that staff have not prevented residents from seeking medical attention when needed.

Facility does not have enough staff to meet the needs of resident in care.
Interview with staff indicated there are 4-5 staff for morning shift, 4 staff for afternoon shift, and 2 staff for night shift. Staff stated that the resident's needs are being met. Interview with residents revealed that staff is available when needed. Staff schedule indicates there are additional staff to cover for those staff who calls in sick or are on vacation.

Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did occur, therefore these allegations are UNSUBSTANTIATED.

No deficiencies are being cited on this date.

Exit interview conducted. A copy of this report provided.
SUPERVISORS NAME: Harpreet Humpal
LICENSING EVALUATOR NAME: Grace Luk
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
LIC9099 (FAS) - (06/04)
Page: 2 of 2