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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 019200734
Report Date: 04/15/2025
Date Signed: 04/15/2025 04:07:15 PM

Substantiated


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
05/20/2024 and conducted by Evaluator Daisy Panlilio
COMPLAINT CONTROL NUMBER: 15-AS-20240520131013
FACILITY NAME:JOY SENIOR CENTERFACILITY NUMBER:
019200734
ADMINISTRATOR:MATHARU, GURPREETFACILITY TYPE:
740
ADDRESS:6400 BRENTWOOD BLVDTELEPHONE:
(510) 543-4695
CITY:BRENTWOODSTATE: CAZIP CODE:
94513
CAPACITY:0CENSUS: 16DATE:
04/15/2025
UNANNOUNCEDTIME BEGAN:
02:00 PM
MET WITH:Sakaraia Kata, Staff (S1)
Gurpreet Matharu, Administrator		TIME COMPLETED:
05:30 PM
ALLEGATION(S):
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Resident sustained an unexplained fracture while in care
INVESTIGATION FINDINGS:
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On 04/15/25 at 2PM, Licensing Program Analyst (LPA) D Panlilio conducted a subsequent visit and met with staff (S1) and spoke with administrator (ADM) on the phone who authorized S1 to act on his behalf and sign the reports. LPA explained the purpose of the visit with staff and delivered investigation findings.

During investigation, the department obtained the following documents from administrator – R1’s admission agreement, physician's report, Needs/Services plan, appraisals, incident reports, hospital visit discharge reports, visitor logs (Mar, Apr, May 2024) Level of care notes & ADL schedules. Health & safety check conducted see LIC 809 dated 05/23/24.

Continued on next page, LIC 9099-C
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Bennett Fong
LICENSING EVALUATOR NAME: Daisy Panlilio
LICENSING EVALUATOR SIGNATURE:

DATE: 04/15/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/15/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 1 of 6
Control Number 15-AS-20240520131013
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: JOY SENIOR CENTER
FACILITY NUMBER: 019200734
VISIT DATE: 04/15/2025
NARRATIVE
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Allegation: Resident sustained an unexplained fracture while in care
Investigation Finding: Substantiated
During investigation, the department conducted interviews of residents (R1, R2, R3), facility staff (ED, S1, S2) & R1’s responsible party (POA) and reviewed resident (R1) documents. Review of R1’s records showed she was first admitted at the facility on 03/08/24 and resided at the facility for a couple of months. R1 was assessed as having dementia, ambulatory with a walker, needs assistance transferring in & out of bed, dressing and a high risk for falls. On 04/14/24, R1 was diagnosed with a displaced fracture of the left wrist. R1 stated that she hurt her left wrist at the facility when she fell out of bed. Staff (S1, S2) stated R1 had three falls at the facility (2 unwitnessed falls at night and one unwitnessed fall in the daytime) while at the facility. S2 stated that he found R1 on the floor on 2 separate occasions. R1 did not complain of any pain and helped her get back to bed. S2 confirmed that there were no fall precautions in place after R1’s repeated falls and that her repeated falls were not documented. Based on the department’s observations and interviews which were conducted and record review(s), the preponderance of evidence standard has been met, therefore the above allegation(s) that resident sustained an unexplained fracture while in care was found to be substantiated.

Immediate civil penalty of $500 assessed during visit for staff failing to provide adequate care and supervision to resident resulting in hospitalization and sustaining unexplained injuries while in care. Additional civil penalty determination is pending relating to resident’s serious bodily injury.

Deficiency is cited per Title 22 California Code of Regulations and listed on LIC9099D. Failure to submit proof of corrections (POC) by plan of correction due dates and/or any repeat deficiencies within a 12-month period may result in civil penalties.

Exit interview conducted, appeal rights and copy of report provided.

SUPERVISORS NAME: Bennett Fong
LICENSING EVALUATOR NAME: Daisy Panlilio
LICENSING EVALUATOR SIGNATURE:

DATE: 04/15/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/15/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 6
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
05/20/2024 and conducted by Evaluator Daisy Panlilio
COMPLAINT CONTROL NUMBER: 15-AS-20240520131013

FACILITY NAME:JOY SENIOR CENTERFACILITY NUMBER:
019200734
ADMINISTRATOR:MATHARU, GURPREETFACILITY TYPE:
740
ADDRESS:6400 BRENTWOOD BLVDTELEPHONE:
(510) 543-4695
CITY:BRENTWOODSTATE: CAZIP CODE:
94513
CAPACITY:0CENSUS: 16DATE:
04/15/2025
UNANNOUNCEDTIME BEGAN:
02:00 PM
MET WITH:Sakaraia Kata, Staff
Gurpreet Matharu, Administrator		TIME COMPLETED:
05:30 PM
ALLEGATION(S):
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Resident sustained unexplained injuries while in care
Staff did not ensure resident’s diapering needs are being met in a timely manner
Staff does not ensure resident’s showering needs are being met
INVESTIGATION FINDINGS:
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On 04/15/25 at 2PM, Licensing Program Analyst (LPA) D Panlilio conducted a subsequent visit and met with staff (S1) and spoke with administrator (ADM) on the phone who authorized S1 to act on his behalf and sign the reports. LPA explained the purpose of the visit with staff and delivered investigation findings.

During investigation, the department obtained the following documents from administrator – R1’s admission agreement, physician's report, Needs/Services plan, appraisals, incident reports, hospital visit discharge reports, visitor logs (Mar, Apr, May 2024) Level of care notes & ADL schedules. Health & safety check conducted see LIC 809 dated 05/23/24.

Continued on next page, LIC 9099-C pg2
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Bennett Fong
LICENSING EVALUATOR NAME: Daisy Panlilio
LICENSING EVALUATOR SIGNATURE:

DATE: 04/15/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/15/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 3 of 6
Control Number 15-AS-20240520131013
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: JOY SENIOR CENTER
FACILITY NUMBER: 019200734
VISIT DATE: 04/15/2025
NARRATIVE
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Allegation: Resident sustained unexplained injuries while in care
Investigation Finding: Unsubstantiated
During investigation, the department conducted interviews of residents (R1, R2, R3), facility staff (ED, S1, S2, S3) & R1’s responsible party (POA) and reviewed resident (R1) documents. S1 and R2 denied hitting R1. Staff (ED, S1, S2) confirmed that R1 sustained unexplained injuries while at the facility. S3 stated that on 05/21/24 at around 0710 AM she observed R1’s face was bruised with her lip slightly bleeding. S3 observed R1 sitting in her chair instead of sleeping on her bed while R1’s roommate (R2) was sleeping in R1’s bed instead. S3 stated that she asked R1 what happened and R1 stated that R2 hit her. Staff notified R1’s POA about the incident. Later at breakfast, S3 stated that R1 changed her story and said that staff (S1) hit her instead of R2. Although the allegation may have happened or are valid, there is not a preponderance of the evidence to prove that the alleged violation occurred. Therefore, the allegation that resident sustained unexplained injuries while in care is unsubstantiated.

Allegation: Staff did not ensure resident’s diapering needs are being met in a timely manner
Investigation Finding: Unsubstantiated
During investigation, the department conducted interviews of facility staff & responsible parties and reviewed resident (R1) documents. Review of R1’s bowel movement/pee records dated 03/10/24 until 05/28/24 showed staff assisted R1 with her toileting needs and changed her diapers frequently (3 to 6 times per day). Staff (ED, S1, S2) stated that they showered, changed residents’ diapers/clothes based on their preferred daily and weekly personal hygiene schedules which they recorded each month. Although the allegation may have happened or are valid, there is not a preponderance of the evidence to prove that the alleged violation occurred. Therefore, the allegation that staff did not ensure resident’s diapering needs are being met in a timely manner is unsubstantiated.

Continued on next page, LIC 9099-C pg3
SUPERVISORS NAME: Bennett Fong
LICENSING EVALUATOR NAME: Daisy Panlilio
LICENSING EVALUATOR SIGNATURE:

DATE: 04/15/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/15/2025
LIC9099 (FAS) - (06/04)
Page: 4 of 6
Control Number 15-AS-20240520131013
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: JOY SENIOR CENTER
FACILITY NUMBER: 019200734
VISIT DATE: 04/15/2025
NARRATIVE
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Allegation: Staff does not ensure resident’s showering needs are being met
Investigation Finding: Unsubstantiated
During investigation, the department conducted interviews of facility staff & responsible parties and reviewed resident (R1) documents. Review of R1’s monthly shower schedules dated 03/10/24 until 05/28/24 showed that staff gave R1 showers according to family schedules on 03/10, 03/11, 03/15, 03/16, 03/19, 03/23, 03/26, 03/27, 03/31, 04/01, 04/09, 04/09, 04/14, 04/23, 04/24, 04/29 and every Monday, Wednesday and Friday for the whole month of May 2024. Although the allegation may have happened or are valid, there is not a preponderance of the evidence to prove that the alleged violation occurred. Therefore, the allegation that staff did not ensure resident’s showering needs are being met is unsubstantiated.

Exit interview conducted and a copy of this report provided.
SUPERVISORS NAME: Bennett Fong
LICENSING EVALUATOR NAME: Daisy Panlilio
LICENSING EVALUATOR SIGNATURE:

DATE: 04/15/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/15/2025
LIC9099 (FAS) - (06/04)
Page: 5 of 6
Control Number 15-AS-20240520131013
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: JOY SENIOR CENTER
FACILITY NUMBER: 019200734
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/15/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
04/18/2025
Section Cited
CCR
87468.2(a)(4)
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Residents in privately operated residential care facilities for the elderly shall have all of the following personal rights: To care, supervision, and services that meet their individual needs and are delivered by staff that are sufficient in numbers, qualifications, and competency to meet their needs…
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By POC due date, administrator agreed to complete and submit in-service staff retraining certifications by an approved CCL vendor on personal rights of residents in compliance with Section 87468.2 (a)(4).
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This requirement was not met as evidenced by staff failing to provide adequate care & supervision which posed an immediate health & safety risk to residents in care.
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Immediate civil penalty of $500 assessed during visit for serious bodily injury. Additional civil penalty determination pending relating to serious bodily injury.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISORS NAME: Bennett Fong
LICENSING EVALUATOR NAME: Daisy Panlilio
LICENSING EVALUATOR SIGNATURE:

DATE: 04/15/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/15/2025
LIC9099 (FAS) - (06/04)
Page: 6 of 6