019200722-5-4-2022-15-AS-KHOS-CE6HJJ-20220506061425

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 019200722
Report Date: 12/22/2021
Date Signed: 05/04/2022 09:02:23 AM

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

PUBLIC

COMPLAINT CONTROL NUMBER: 15-AS-20210614083319

FACILITY NAME:	SUNRISE OF PLEASANTON		FACILITY NUMBER:	019200722
ADMINISTRATOR:	MALEK, MELISSA		FACILITY TYPE:	740
ADDRESS:	5700 PLEASANT HILL RD		TELEPHONE:	(925) 416-0238
CITY:	PLEASANTON	STATE: CA	ZIP CODE:	94588
CAPACITY:	103	CENSUS: 78	DATE:	12/22/2021
		UNANNOUNCED	TIME BEGAN:	12:30 PM
MET WITH:	Tracy Burke		TIME COMPLETED:	04:30 PM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

1. Staff placed resident pendent out of reach.

INVESTIGATION FINDINGS:

1
2
3
4
5
6
7
8
9
10
11
12
13

*This is an amended report to the original 9099 delivered on 12/22/2021.

On 4/13/2022, Licensing Program Analysts (LPAs) James Sampair and L. Ibo conducted an unannounced 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 Tracy Burke.

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 Administrator (S4) shared that updated information with LPA O'Halleran on 06/30/2021. LPA J. Sampair conducted records review, on facility’s pendant call activity report from June 10,2021 – June 12, 2021, staff maximum response time to a call light is in between 1min-12mins., based on interview with S4, facility do not have specific policy on the time frame for staff to respond to pendant calls. S4 also stated that “if it goes longer than 20 minutes I’d be concerned”.

Therefore, based on interviews and record review conducted by the Department- the allegation is Unsubstantiated. Although the allegation may have happened or may be valid, there is not a preponderance of evidence to prove the alleged violation, did or did not occur, therefore the allegation is unsubstantiated.

No citation was made during this visit. Exit interview was conducted Executive Director Tracy Burke and a copy of this report provided

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Harpreet Humpal	TELEPHONE: (510) 285-3928
LICENSING EVALUATOR NAME: James Sampair	TELEPHONE: (510) 286-4201
LICENSING EVALUATOR SIGNATURE:	DATE: 04/19/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/19/2022

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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