019200708-1-5-2024-15-AS-HHUL-CZMQES-20240119110645

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 019200708
Report Date: 01/05/2024
Date Signed: 01/05/2024 06:56:18 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
09/20/2022 and conducted by Evaluator Grace Luk

PUBLIC

COMPLAINT CONTROL NUMBER: 15-AS-20220920152014

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: 84	DATE:	01/05/2024
		UNANNOUNCED	TIME BEGAN:	10:30 AM
MET WITH:	Chelsea Espinoza, Executive Director		TIME COMPLETED:	07:00 PM

ALLEGATION(S):

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Facility did not change and wash resident's clothes while in care.
Facility did not meet resident's hygiene needs while in care.
Facility did not ensure that resident's nails were cut while in care.
Facility did not seek resident medical attention for an infection while in care.

INVESTIGATION FINDINGS:

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On 1/5/2024 at 10:30AM, Licensing Program Analyst (LPA) G. Luk arrived unannounced to conduct complaint investigation and to deliver complaint findings for the allegations above. LPA met with Executive Director, Chelsea Espinoza and explained the purpose of the visit.

During the investigation, LPA interviewed 6 residents, 6 staff, 1 witness, and complainant. LPA reviewed and obtained documents including staff roster with phone numbers, admission agreement, physician's report, care plan, emergency information, 24 hour reports, changes in condition procedure, and hospice care plan.

Facility did not change and wash resident's clothes while in care.
Interview with residents revealed that laundry is done once a week. Interview with staff indicated that laundry and rooms are cleaned once a week. S5 stated that R1 rarely refused laundry service or room cleaning.
(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: 01/05/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/05/2024

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-20220920152014

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: 01/05/2024

NARRATIVE

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Facility did not meet resident's hygiene needs while in care.
Interview with staff revealed that R1 would refuse assistance with shower and dressing. LPA observed R1's assessment dated 9/29/2021 indicated that R1 does not need assistance with grooming, bathing, dressing, eating, toileting, and transferring.

Facility did not ensure that resident's nails were cut while in care.
Interview with residents revealed there was services residents can sign up for to get assistance with finger and toe nails trimming. R1's assessment dated 9/29/2021 did not indicate that R1 needed assistance with finger and toe nails trimming.

Facility did not seek resident medical attention for an infection while in care.
Interview with residents revealed that when call button is activated, staff would come and assist residents. S2 stated there's no recollection of R1 having an infection that needed medical attention. R1's assessment and 24 hour reports does not indicate that R1 had a change in condition. There was lack of evidence to prove facility did not seek medical attention for R1.

Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violation did occur, therefore these allegations are 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: 01/05/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/05/2024

LIC9099 (FAS) - (06/04)

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