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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 019200722
Report Date: 12/22/2021
Date Signed: 12/22/2021 04:26:58 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
06/14/2021 and conducted by Evaluator James Sampair
COMPLAINT CONTROL NUMBER: 15-AS-20210614083319
FACILITY NAME:SUNRISE OF PLEASANTONFACILITY NUMBER:
019200722
ADMINISTRATOR:MALEK, MELISSAFACILITY TYPE:
740
ADDRESS:5700 PLEASANT HILL RDTELEPHONE:
(925) 416-0238
CITY:PLEASANTONSTATE: CAZIP CODE:
94588
CAPACITY:103CENSUS: 78DATE:
12/22/2021
UNANNOUNCEDTIME BEGAN:
12:30 PM
MET WITH:Tracy BurkeTIME COMPLETED:
04:30 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
1. Staff did not assist resident with incontinence.
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
On 12/22/2021 at 12:30PM, Licensing Program Analyst (LPA) James Sampair conducted a subsequent complaint visit and met with Executive Director (ED) Tracy Burke to interview her and to deliver the investigation findings. LPA explained the purpose of the visit with ED.

LPA interviewed ED Burke on employee S3 who had worked the night shift 06/11/2021 and who was subsequently fired for sleeping on the job as per former ED Melissa Malek who shared that updated information with LPA O'Halleran on 06/30/2021.

Based on the review of the records and interviews of staff and residents, the Department found that the allegation was UNSUBSTANTIATED, meaning that the allegation may have happened or is valid, but there is not a preponderance of evidence to prove the alleged violation did or did not occur.

An exit interview was conducted. A copy of this report and a copy of the Appeal Rights were provided.
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Harpreet HumpalTELEPHONE: (510) 285-3928
LICENSING EVALUATOR NAME: James SampairTELEPHONE: (510) 286-4201
LICENSING EVALUATOR SIGNATURE:

DATE: 12/22/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/22/2021
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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