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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 019200722
Report Date: 12/14/2022
Date Signed: 12/14/2022 09:56:56 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
09/12/2022 and conducted by Evaluator Kelly Nguyen
COMPLAINT CONTROL NUMBER: 15-AS-20220912144942
FACILITY NAME:SUNRISE OF PLEASANTONFACILITY NUMBER:
019200722
ADMINISTRATOR:TRACY BURKEFACILITY TYPE:
740
ADDRESS:5700 PLEASANT HILL RDTELEPHONE:
(925) 416-0238
CITY:PLEASANTONSTATE: CAZIP CODE:
94588
CAPACITY:103CENSUS: 77DATE:
12/14/2022
UNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Tracy Burke, Executive Director TIME COMPLETED:
10:05 AM
ALLEGATION(S):
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9
Staff are not properly assessing residents for change in health
Staff are not providing residents with medication in a timely manner
Staff do not have access to necessary supplies
INVESTIGATION FINDINGS:
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On 12/14/2022 at 9:00AM Licensing Program Analyst (LPA) K. Nguyen arrived unannounced to deliver finding for the above allegations. LPA met with Executive Director Tracy Burke and explained the purpose of the visit.

Based on record reviews and interviews, facility staff are properly assessing residents for their change in health condition and are providing residents with medication in a timely manner. Interviewed 7 staff 7 out of 7 states that they all have access to necessary supplies. Executive director, business coordinator, leads staff, medical director, and housekeeper always have keys available for staff to assess the supply room.

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

Exit Interview conducted and a copy of this report provided.
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Bennett FongTELEPHONE: (510) 725-7919
LICENSING EVALUATOR NAME: Kelly NguyenTELEPHONE: (510) 915-8702
LICENSING EVALUATOR SIGNATURE:

DATE: 12/14/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/14/2022
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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