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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 019200873
Report Date: 01/10/2023
Date Signed: 01/10/2023 11:42:21 AM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
E BAY DELTA AC/SC, 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
01/05/2023 and conducted by Evaluator Catherine Lin
PUBLIC
COMPLAINT CONTROL NUMBER: 15-AS-20230105094225
FACILITY NAME:POINT AT ROCKRIDGE, THEFACILITY NUMBER:
019200873
ADMINISTRATOR:KNOX, KATHLEEN LFACILITY TYPE:
740
ADDRESS:4500 GILBERT STREETTELEPHONE:
(510) 658-9266
CITY:OAKLANDSTATE: CAZIP CODE:
94611
CAPACITY:186CENSUS: 129DATE:
01/10/2023
UNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Roselynn Muzzy, Regional Vice PresidentTIME COMPLETED:
11:55 AM
ALLEGATION(S):
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Financial abuse
Facility failed to refund after resident deceased
INVESTIGATION FINDINGS:
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On 1/10/2023 at 9:30 AM, Licensing Program Analyst (LPA) C. Lin arrived unannounced to conduct a 10-day initial complaint investigation visit in regard to the above allegations and delivered investigation findings. LPA met with the Regional Vice President and informed the reason for visit.

Allegation: Financial abuse - Substantiated
The Department has investigated this allegation and per records review and interviews found that facility continued to accrue monthly rent to resident who passed on 10/30/2022 and vacant room on 11/19/2022. The last withdrew payment from the resident’s bank account was on 12/6/2022 for the rent of December 2022.


Continue on LIC9099-C
Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Bennett FongTELEPHONE: (510) 622-2621
LICENSING EVALUATOR NAME: Catherine LinTELEPHONE: 510-622-2053
LICENSING EVALUATOR SIGNATURE:

DATE: 01/10/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/10/2023
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 3
Control Number 15-AS-20230105094225
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
E BAY DELTA AC/SC, 1515 CLAY STREET, STE. 310
OAKLAND, CA 94612
FACILITY NAME: POINT AT ROCKRIDGE, THE
FACILITY NUMBER: 019200873
VISIT DATE: 01/10/2023
NARRATIVE
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Allegation: Facility failed to refund after resident deceased - Substantiated
The Department has investigated this allegation and per records review and interviews found that the resident passed on 10/30/2022, resident's representative had the room vacant on 11/19/2022, the partial month of rent has not been refunded timely.

Based on information obtained, the preponderance of evidence is met, therefore the allegations are substantiated.

Deficiencies are cited from Title 22 California Code of Regulations (see 9099D). Failure to submit proof of correction by plan of correction due date and any repeat violation within 12 month period may result in civil penalty.

Deficiencies and plan and proof of correction were discussed with Regional Vice President. Exit interview conducted. Appeal Rights, LIC9099D, and copy this report provided.
SUPERVISOR'S NAME: Bennett FongTELEPHONE: (510) 622-2621
LICENSING EVALUATOR NAME: Catherine LinTELEPHONE: 510-622-2053
LICENSING EVALUATOR SIGNATURE:

DATE: 01/10/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/10/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 15-AS-20230105094225
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
E BAY DELTA AC/SC, 1515 CLAY STREET, STE. 310
OAKLAND, CA 94612

FACILITY NAME: POINT AT ROCKRIDGE, THE
FACILITY NUMBER: 019200873
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/10/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
01/17/2023
Section Cited
HSC
1569.652(a)
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1569.652 Termination of admission agreement upon death of resident...
(a) No fees shall accrue once all personal property belonging to the deceased resident is removed from the living unit.

This requirement is not met as evidenced by…
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Regional Vice President agrees to review regulations and retrain staff, submit proof of in-service training with staff signatures to CCL by POC due date.
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Based on observation, record review, and interview, the licensee did not comply with the section cited above, LPA observed that resident who passed on 10/30/22 and monthly rent was accured for December 2022 which poses/posed a potential health, safety or personal rights risk to persons in care.
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Type B
01/17/2023
Section Cited
HSC
1569.652(c)
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1569.652 Termination of admission agreement upon death of resident...
(c) A refund of any fees...within 15 days after the personal property is removed.

This requirement is not met as evidenced by…
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Regional Vice President agrees to review regulations and retrain staff, submit proof of in-service training with staff signatures to CCL by POC due date.
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Based on observation, record review, and interview, the licensee did not comply with the section cited above, LPA observed that resident who passed on 10/30/22 and room vacant on 11/19/22 but was not received refund for partial of rent timely which poses/posed a potential health, safety or personal rights risk to persons in care.
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RP received two refund checks $2302 & $9655 on today's date.
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME: Bennett FongTELEPHONE: (510) 622-2621
LICENSING EVALUATOR NAME: Catherine LinTELEPHONE: 510-622-2053
LICENSING EVALUATOR SIGNATURE:

DATE: 01/10/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/10/2023
LIC9099 (FAS) - (06/04)
Page: 3 of 3