019200755-11-9-2022-15-AS-KHOS-CLUNQZ-20221206094046

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 019200755
Report Date: 11/09/2022
Date Signed: 11/09/2022 02:32:42 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
11/02/2022 and conducted by Evaluator Kelly Nguyen

COMPLAINT CONTROL NUMBER: 15-AS-20221102143420

FACILITY NAME:	SUNRISE ASSISTED LIVING OF OAKLAND HILLS		FACILITY NUMBER:	019200755
ADMINISTRATOR:	CAGULADA, DILLON R		FACILITY TYPE:	740
ADDRESS:	11889 SKYLINE BLVD		TELEPHONE:	(510) 531-7190
CITY:	OAKLAND	STATE: CA	ZIP CODE:	94619
CAPACITY:	100	CENSUS: 80	DATE:	11/09/2022
		UNANNOUNCED	TIME BEGAN:	12:15 PM
MET WITH:	DILLON CAGULADA, Executive Director		TIME COMPLETED:	02:40 PM

ALLEGATION(S):

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Staff did not safeguard Resident's Personal Property

INVESTIGATION FINDINGS:

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On 11/09/2022 at 12:15PM Licensing Program Analyst (LPA) K. Nguyen, arrived unannounced to conduct investigation on the above allegations. LPA met with Dillion Cagulada, Executive Director and explained the purpose of the visit.

It was alleged that Staff did not safeguard Resident's Personal Property. During the course of investigation, LPA reviewed staff schedule, resdient roster, and conducted interviews to find that facility took action and conducted an inhouse investigation. LPA observed that facility provided a safe lock for resident to store their valuable/ belonging. LPA review S1 accommodation to R1 and obtained proof of accommodation.

Unsubstantiated:

Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation(s) did or did not occur, therefore the allegation is UNSUBSTANTIATED.
Exit interview conducted and a copy of the report of given to Executive Director.

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: 11/09/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/09/2022

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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