019200708-7-29-2022-15-AS-HHUL-CMBVTD-20221221154259

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 019200708
Report Date: 07/29/2022
Date Signed: 07/29/2022 05:06:42 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
03/09/2022 and conducted by Evaluator Grace Luk

PUBLIC

COMPLAINT CONTROL NUMBER: 15-AS-20220309150250

FACILITY NAME:	WATERMARK AT ROSEWOOD GARDENS, THE		FACILITY NUMBER:	019200708
ADMINISTRATOR:	HARRISON, NANCY		FACILITY TYPE:	740
ADDRESS:	35 FENTON STREET		TELEPHONE:	(925) 443-7200
CITY:	LIVERMORE	STATE: CA	ZIP CODE:	94550
CAPACITY:	115	CENSUS: 55	DATE:	07/29/2022
		UNANNOUNCED	TIME BEGAN:	12:00 PM
MET WITH:	Will Pringle, Executive Director		TIME COMPLETED:	03:00 PM

ALLEGATION(S):

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Financial Abuse

INVESTIGATION FINDINGS:

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On 7/29/2022 at 12:00PM, Licensing Program Analyst (LPA) G. Luk arrived unannounced to conduct complaint investigation and to deliver complaint findings for the allegation above. LPA met with Executive Director, Will Pringle.

During the investigation, LPA interviewed 5 staff, 1 resident, and 1 witness. LPA reviewed and obtained documents including LIC500, incident report, facility investigation documents, copies of checks, physician's report, care plan, admission agreement, and emergency information.

Interview with staff indicated that R1 had written a check to a staff (S4), but the check was not cashed or deposited. LPA reviewed R1's records and observed R1's medical assessment dated 1/4/2022 did not indicate R1 had dementia diagnosis. R1's admission agreement stated that R1 was the responsible party. (Continue on LIC9099C...)

Unsubstantiated

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: 07/29/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/29/2022

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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Control Number 15-AS-20220309150250

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: WATERMARK AT ROSEWOOD GARDENS, THE	FACILITY NUMBER: 019200708
	VISIT DATE: 07/29/2022

NARRATIVE

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Interview with R1 revealed that R1 wrote a check to S4 to pay for tuition and the bank never got the check because it was tore up. R1 stated that R1 asked S4 and instigated the conversation about how much tuition would cost. R1 also stated that this was the only time R1 wrote a check to S4 or other staff. S1 stated that S4 was terminated after facility investigated the incident.

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

No deficiencies are being cited on this date.

Exit interview conducted. A copy of this report provided.

SUPERVISOR'S NAME: Harpreet Humpal	TELEPHONE: (510) 285-3928
LICENSING EVALUATOR NAME: Grace Luk	TELEPHONE: (510) 286-4201
LICENSING EVALUATOR SIGNATURE:	DATE: 07/29/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/29/2022

LIC9099 (FAS) - (06/04)

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