019200521-9-7-2022-15-AS-KHOS-CKAN49-20221017100735

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 019200521
Report Date: 09/07/2022
Date Signed: 09/07/2022 12:53:45 PM

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 Kelly Nguyen

COMPLAINT CONTROL NUMBER: 15-AS-20220830110619

FACILITY NAME:	CREEKVIEW ASSISTED LIVING		FACILITY NUMBER:	019200521
ADMINISTRATOR:	PATRICK D. MCELROY		FACILITY TYPE:	740
ADDRESS:	2900 STONERIDGE DRIVE		TELEPHONE:	(925) 353-5717
CITY:	PLEASANTON	STATE: CA	ZIP CODE:	94588
CAPACITY:	136	CENSUS: 70	DATE:	09/07/2022
		UNANNOUNCED	TIME BEGAN:	11:42 AM
MET WITH:	Patick Mcelroy, Adminstrator		TIME COMPLETED:	01:00 PM

ALLEGATION(S):

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Staff are interfering with a resident's medical record while in care

INVESTIGATION FINDINGS:

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On 9/07/2022 at 11:40AM Licensing Program Analyst (LPA) K. Nguyen arrived unannounced to conduct initial 10-day complaint investigation for the above allegations. LPA met with Assisted Living Administrator, Patrick Mcelroy, and explained the purpose of the visit.

It was alleged that staff are interfering with a resident's medical record while in care. LPA review resident file; interview Administrator. It was found that the resident is not in assisted living nor memory care, and staff did not interfere with resident’s medical record. Therefore, the allegation is Unfounded.

Per records review and interviews, the Department has investigated this complaint and has determined it to be Unfounded, meaning that the allegation was false, could not have happened and/or is without reasonable basis. We have therefore dismissed the complaint.

An exit interview was conducted, and a copy of this report was provided.

Unfounded

Estimated Days of Completion:

SUPERVISOR'S NAME: Bennett Fong	TELEPHONE: (510) 725-7919
LICENSING EVALUATOR NAME: Kelly Nguyen	TELEPHONE: (510) 915-8702
LICENSING EVALUATOR SIGNATURE:	DATE: 09/07/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/07/2022

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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