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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 019200474
Report Date: 09/14/2021
Date Signed: 09/14/2021 10:26:01 AM



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
08/17/2021 and conducted by Evaluator Allison O'Hollaren
PUBLIC
COMPLAINT CONTROL NUMBER: 15-AS-20210817085255
FACILITY NAME:STONERIDGE CREEK PLEASANTONFACILITY NUMBER:
019200474
ADMINISTRATOR:EZEKIEL GRIFFINFACILITY TYPE:
740
ADDRESS:3300 STONERIDGE CREEK WAYTELEPHONE:
(925) 201-4000
CITY:PLEASANTONSTATE: CAZIP CODE:
94588
CAPACITY:828CENSUS: 771DATE:
09/14/2021
UNANNOUNCEDTIME BEGAN:
10:15 AM
MET WITH:Ezekiel GriffinTIME COMPLETED:
10:30 AM
ALLEGATION(S):
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Facility is in disrepair, water supply is contaminated
INVESTIGATION FINDINGS:
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On 09/14/2021 at approximately 10:15am Licensing Program Analyst (LPA) Allison O'Hollaren arrived unannounced to conduct a complaint visit meeting with Administrator Ezekiel Griffin. The purpose of the visit was to deliver findings on the above allegation.

During the course of the investigation, LPAs Allison O'Hollaren and Jill Clancy-Czuleger interviewed Administrator and five residents, interviewed City of Pleasanton Labratory Services Specialist (E1), collected water from five residents' (R1, R2, R3, R4, and R5) apartments, and reviewed water quality information documents, email communications with the facility and City of Pleasanton water specialist employees, and water analysis reports. During interviews and reviewing records it was revealed that the facility received

Continued on LIC9099C...
Unfounded
Estimated Days of Completion:
SUPERVISOR'S NAME: Yvonne Flores-LariosTELEPHONE: (510) 286-0517
LICENSING EVALUATOR NAME: Allison O'HollarenTELEPHONE: (510) 286-4201
LICENSING EVALUATOR SIGNATURE:

DATE: 09/14/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/14/2021
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-20210817085255
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: STONERIDGE CREEK PLEASANTON
FACILITY NUMBER: 019200474
VISIT DATE: 09/14/2021
NARRATIVE
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a complaint from Resident R1 regarding the appearance of water. The facility paid for company, Culligan Water to test water out of R1's apartment. Email communications reveal facility consulted with City of Pleasanton employees regarding water analysis report from Culligan Water and the results show that the water from R1's apartment meets all regulatory requirements.

This agency has investigated the complaint allegation. 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.

Exit interview conducted with Administrator and a copy of this report provided.
SUPERVISOR'S NAME: Yvonne Flores-LariosTELEPHONE: (510) 286-0517
LICENSING EVALUATOR NAME: Allison O'HollarenTELEPHONE: (510) 286-4201
LICENSING EVALUATOR SIGNATURE:

DATE: 09/14/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/14/2021
LIC9099 (FAS) - (06/04)
Page: 2 of 2