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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 019200474
Report Date: 09/13/2023
Date Signed: 09/18/2023 10:59:27 AM


Document Has Been Signed on 09/18/2023 10:59 AM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

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



FACILITY NAME:STONERIDGE CREEK PLEASANTONFACILITY NUMBER:
019200474
ADMINISTRATOR:EZEKIEL GRIFFINFACILITY TYPE:
741
ADDRESS:3300 STONERIDGE CREEK WAYTELEPHONE:
(925) 201-4000
CITY:PLEASANTONSTATE: CAZIP CODE:
94588
CAPACITY:828CENSUS: DATE:
09/13/2023
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Ezekiel GriffinTIME COMPLETED:
09:15 AM
NARRATIVE
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The Continuing Care Contracts Bureau (CCCB) conducted an unannounced call with Ezekiel Griffin, Executive Director -Stoneridge (ED), on March 1, 2022 and March 9 and Warren Spieker, Managing Partner of Continuing Life, Inc. (MP) on December 14, 2022 regarding an investigation in to allegations made.

During the investigation CCCB, in its review of the Budget Presentation PowerPoints found that the comparative data was missing the YTD actuals as required by H&SC 1771.8 (d). However, during the interview that occurred on December 14, 2022, between the Department and the Provider regarding the missing information, the Provider submitted the current 2023 budget presentation information, and the actual data was included.

The Department has determined this is a violation of H&SC 1771.8(d) due to lack including the actual data in the prior years, however, as of the date of these findings, it has been corrected.

The Department is imposing a $1,000 administrative fine as provided for in H&SC section 1793.27(a).

The administrative fine shall be paid by check made payable to the CCRC Oversight Fund within 14 days of delivery these finding (9/13/2023).

LIC809 AND LIC809-D shared via Teams with Ezekiel Griffin 9/16/2023 at 9:30am. Signed copied emailed.

SUPERVISOR'S NAME: Allison NakatomiTELEPHONE: (916) 531-5336
LICENSING EVALUATOR NAME: Jennifer WaldenTELEPHONE: (916) 651-8148
LICENSING EVALUATOR SIGNATURE:
DATE: 09/13/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/13/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
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Document Has Been Signed on 09/18/2023 10:59 AM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION 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

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/13/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
09/13/2023
Section Cited
HSC
1771.8(d)

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In the Department's review of the Budget Presentation PowerPoints it found that the comparative data was missing the YTD actuals as required by H&SC 1771.8 (d).
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During the interview that occurred on December 14, 2022, between the Department and the Provider regarding the missing information, the Provider submitted the current 2023 budget presentation information, and the actual data was included. Provider stated that the YTD actual data will be included moving forward.
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The Department is imposing a $1,000 administrative fine as provided for in H&SC section 1793.27(a).

The administrative fine shall be paid by check made payable to the CCRC Oversight Fund within 14 days of delivery of these findings (09/13/2023).

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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME: Allison NakatomiTELEPHONE: (916) 531-5336
LICENSING EVALUATOR NAME: Jennifer WaldenTELEPHONE: (916) 651-8148
LICENSING EVALUATOR SIGNATURE:
DATE: 09/13/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/13/2023
LIC809 (FAS) - (06/04)
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