015601095-9-8-2022-15-AS-KHOS-CM5QCP-20221215110329

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 015601095
Report Date: 09/08/2022
Date Signed: 09/08/2022 11:39:33 AM

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
08/30/2022 and conducted by Evaluator Grace Luk

PUBLIC

COMPLAINT CONTROL NUMBER: 15-AS-20220830134226

FACILITY NAME:	HERITAGE ESTATES		FACILITY NUMBER:	015601095
ADMINISTRATOR:	BATTISTI, STEVE		FACILITY TYPE:	740
ADDRESS:	900 E STANLEY BLVD		TELEPHONE:	(925) 373-3636
CITY:	LIVERMORE	STATE: CA	ZIP CODE:	94550
CAPACITY:	65	CENSUS: 50	DATE:	09/08/2022
		UNANNOUNCED	TIME BEGAN:	09:10 AM
MET WITH:	Steve Battisti, Administrator		TIME COMPLETED:	11:50 PM

ALLEGATION(S):

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Facility did not assist resident after sustaining a fall.
Staff is unable to meet the resident's needs.

INVESTIGATION FINDINGS:

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On 9/8/2022 at 9:10AM, Licensing Program Analysts (LPAs) G. Luk and J. Sampair arrived unannounced to conduct a complaint investigation and deliver findings regarding the allegations above. LPAs met with administrator, Steve Battisti, and informed him of the reason for the visit.

During the course of investigation, LPAs interviewed staff, witness, and complainant. After reviewing the resident roster, LPAs observed R1 was a resident from the independent living side of the facility. Interview with staff and witness revealed that R1 lives in the independent side of the facility. W1 stated that R1 has family members that would visit regularly and provide care as needed. R1 is independent and does not need ADL care.

This agency has investigated the complaint allegations. We have found that the complaint was UNFOUNDED, meaning that the allegations were false, could not have happened and/or is without a reasonable basis. Exit interview conducted and a copy of this report provided.

Unfounded

Estimated Days of Completion:

SUPERVISOR'S NAME: Harpreet Humpal	TELEPHONE: (510) 285-3928
LICENSING EVALUATOR NAME: Grace Luk	TELEPHONE: (510) 286-4201
LICENSING EVALUATOR SIGNATURE:	DATE: 09/08/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/08/2022

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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