019200722-3-30-2023-15-AS-KHOS-CQRL3F-20230410082351

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 019200722
Report Date: 03/30/2023
Date Signed: 03/30/2023 11:26:43 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
03/27/2023 and conducted by Evaluator Kelly Nguyen

COMPLAINT CONTROL NUMBER: 15-AS-20230327102604

FACILITY NAME:	SUNRISE OF PLEASANTON		FACILITY NUMBER:	019200722
ADMINISTRATOR:	TRACY BURKE		FACILITY TYPE:	740
ADDRESS:	5700 PLEASANT HILL RD		TELEPHONE:	(925) 416-0238
CITY:	PLEASANTON	STATE: CA	ZIP CODE:	94588
CAPACITY:	103	CENSUS: 83	DATE:	03/30/2023
		UNANNOUNCED	TIME BEGAN:	09:00 AM
MET WITH:	TRACY BURKE, Executive Director		TIME COMPLETED:	11:35 AM

ALLEGATION(S):

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Resident meals are prepared in an unsanitary manner

INVESTIGATION FINDINGS:

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On 3/30/2023 at 9:00 AM, Licensing Program Analyst (LPA) K. Nguyen arrived unannounced to conduct complaint investigation for the above allegation. LPA met with Executive Director Tracy Burke, and explained the purpose of the visit.

It was alleged that Resident meals are prepared in an unsanitary manner. At 9:20am LPA toured the kitchen area, and interviewed four kitchen staff that were present at the time. At 9:25am LPA observed kitchen plates, bowls, and utensils (knives, forks, spoons) are being washed and placed on dry rack. LPA observed staff are labeling the food and stored away properly. LPA observed each station in the kitchen are being wiped down, and things are being stored away.

Report continue on LIC 9099C...

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Bennett Fong	TELEPHONE: (510) 725-7919
LICENSING EVALUATOR NAME: Kelly Nguyen	TELEPHONE: (510) 915-8702
LICENSING EVALUATOR SIGNATURE:	DATE: 03/30/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/30/2023

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-20230327102604

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: SUNRISE OF PLEASANTON	FACILITY NUMBER: 019200722
	VISIT DATE: 03/30/2023

NARRATIVE

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LPA received the complaint on 3/27/23. RP send an email to the complaint unit without leaving any contact information, therefore LPA cannot interview RP or gather more information. However, RP mentioned in the email that one of the staff brought the dog inside the kitchen while staff are preparing meal.

LPA interviewed four kitchen staff. Three out of four stated that they are not aware that there is a dog in the kitchen. S2, S3, and S4 stated that there are no dogs that are present in the kitchen area, while food is being prep. However, S1 admitted that S1 brought S1 dog to the facility, but the dog is kept locked inside S1 office the entire time. S1 asked Executive Director (ED) for permission for S1 to bring the dog to the facility. ED strictly asked S1 to put the dog in S1 office and lock the door. Ed constantly monitor the floor and kitchen to make sure whenever the dog is in S1 office it is kept lock inside. S1 showed LPA the back door that S1 brought the dog to S1 office and demonstrated that the dog would not be able to roam around the kitchen, nor able to get out of S1 office. LPA observed that the dog cannot cross the kitchen area from S1 office to the back door.

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.

SUPERVISOR'S NAME: Bennett Fong	TELEPHONE: (510) 725-7919
LICENSING EVALUATOR NAME: Kelly Nguyen	TELEPHONE: (510) 915-8702
LICENSING EVALUATOR SIGNATURE:	DATE: 03/30/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/30/2023

LIC9099 (FAS) - (06/04)

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