019200873-2-6-2023-15-AS-KHOS-CP4M5T-20230216081853

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 019200873
Report Date: 02/06/2023
Date Signed: 02/06/2023 01:21:26 PM

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
11/21/2022 and conducted by Evaluator Catherine Lin

PUBLIC

COMPLAINT CONTROL NUMBER: 15-AS-20221121093448

FACILITY NAME:	POINT AT ROCKRIDGE, THE		FACILITY NUMBER:	019200873
ADMINISTRATOR:	KNOX, KATHLEEN L		FACILITY TYPE:	740
ADDRESS:	4500 GILBERT STREET		TELEPHONE:	(510) 658-9266
CITY:	OAKLAND	STATE: CA	ZIP CODE:	94611
CAPACITY:	186	CENSUS: 123	DATE:	02/06/2023
		UNANNOUNCED	TIME BEGAN:	11:00 AM
MET WITH:	Laura Benson, Interim Executive Director		TIME COMPLETED:	01:00 PM

ALLEGATION(S):

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Facility is unsanitary

INVESTIGATION FINDINGS:

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On 2/6/23 at 11:00 am, Licensing Program Analyst (LPA) Catherine Lin conducted an unannounced subsequent complaint investigation regarding the above allegations and deliver investigation findings. LPA met with interim executive director (ED) and explained the purpose of the visit.

The Department has investigated this allegation, per observation, records review, interviews, and found that the former Administrator admitted that no janitor was on duty in memory care unit for almost 2 months. Care staff also complained that the place was not clean due to no janitor.

Based on information obtained, the preponderance of evidence is met, therefore the allegation is SUBSTANTIATED.

Continue on LIC9099-C

Substantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Bennett Fong	TELEPHONE: (510) 622-2621
LICENSING EVALUATOR NAME: Catherine Lin	TELEPHONE: 510-622-2053
LICENSING EVALUATOR SIGNATURE:	DATE: 02/06/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/06/2023

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-20221121093448

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: 02/06/2023

NARRATIVE

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Deficiency is cited from Title 22 California Code of Regulations and Health and Safety Code (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.

Deficiency and plan and proof of correction were discussed with interim ED. Exit interview conducted. Appeal Rights, LIC9099D, and copy this report provided.

SUPERVISOR'S NAME: Bennett Fong	TELEPHONE: (510) 622-2621
LICENSING EVALUATOR NAME: Catherine Lin	TELEPHONE: 510-622-2053
LICENSING EVALUATOR SIGNATURE:	DATE: 02/06/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/06/2023

LIC9099 (FAS) - (06/04)

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Control Number 15-AS-20221121093448

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: 02/06/2023

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 02/20/2023 Section Cited CCR 87303(a)	1 2 3 4 5 6 7	87303 Maintenance and Operation (a)The facility shall be clean, safe, sanitary and in good repair at all times.... This requirement is not met as evidenced by…	1 2 3 4 5 6 7	Administrator agrees to review regulation, and submit a self-certification of understanding regulation section code 87303 to CCL by the POC due date.
	8 9 10 11 12 13 14	Based on records review and interview, the licensee did not comply with the section cited above. LPA observed that no janitor was on duty for almost 2 months which poses/posed a potential health, safety or personal rights risk to persons in care.	8 9 10 11 12 13 14
	1 2 3 4 5 6 7		1 2 3 4 5 6 7
	1 2 3 4 5 6 7		1 2 3 4 5 6 7

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 Fong	TELEPHONE: (510) 622-2621
LICENSING EVALUATOR NAME: Catherine Lin	TELEPHONE: 510-622-2053
LICENSING EVALUATOR SIGNATURE:	DATE: 02/06/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/06/2023

LIC9099 (FAS) - (06/04)

Page: 3 of 5

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
11/21/2022 and conducted by Evaluator Catherine Lin

PUBLIC

COMPLAINT CONTROL NUMBER: 15-AS-20221121093448

FACILITY NAME:	POINT AT ROCKRIDGE, THE		FACILITY NUMBER:	019200873
ADMINISTRATOR:	KNOX, KATHLEEN L		FACILITY TYPE:	740
ADDRESS:	4500 GILBERT STREET		TELEPHONE:	(510) 658-9266
CITY:	OAKLAND	STATE: CA	ZIP CODE:	94611
CAPACITY:	186	CENSUS: 123	DATE:	02/06/2023
		UNANNOUNCED	TIME BEGAN:	11:00 AM
MET WITH:	Laura Benson, Interim Executive Director		TIME COMPLETED:	01:00 PM

ALLEGATION(S):

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Resident suffered falls while in care.
Resident was left in soiled bedding for a long period of time.
Resident's hygiene needs are not being met.

INVESTIGATION FINDINGS:

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On 2/6/23 at 11:00 am, Licensing Program Analyst (LPA) Catherine Lin conducted an unannounced subsequent complaint investigation regarding the above allegations and deliver investigation findings. LPA met with interim executive director (ED) and explained the purpose of the visit.

Allegation: Resident suffered falls while in care – Unsubstantiated
The Department has investigated this allegation and per records review and interviews, found that resident R1 had two unwitnessed falls on 11/7/22 and 11/8/22. Staff evaluated R1 and sent R1 to hospital in both incidents. Since R1 has no updated needs and service plan on file, the most recent needs and services plan dated on 9/6/2021 indicated that R1 was not at fall risk. Staff stated that R1 was checked as frequently as needed.

Continue LIC9099-A-C

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Bennett Fong	TELEPHONE: (510) 622-2621
LICENSING EVALUATOR NAME: Catherine Lin	TELEPHONE: 510-622-2053
LICENSING EVALUATOR SIGNATURE:	DATE: 02/06/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/06/2023

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

Page: 4 of 5

Control Number 15-AS-20221121093448

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: 02/06/2023

NARRATIVE

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Allegation: Resident was left in soiled bedding for a long period of time - Unsubstantiated
The Department has investigated this allegation and per records review and interviews, found staff denied resident was left in soiled bedding for a long period of time. Staff stated that they frequently checked on residents and changed residents as needed. Since resident R1 has no updated physician’s report on file, the most recent physician’s report dated on 9/30/2021 indicated that R1 was able to care for own toileting needs.

Allegation: Resident's hygiene needs are not being met - Unsubstantiated
The Department has investigated this allegation and per records review, observation, and interviews, found that facility staff washed residents’ laundry every day. Dirty laundry was observed in different location each room, some were placed inside or outside the closet, some were placed in the living room, and some were placed in bathroom. Staff stated that laundry was placed in the location where resident preferred.

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

No deficiency cited. Exit interview conducted with interim ED and a copy of this report provided.

SUPERVISOR'S NAME: Bennett Fong	TELEPHONE: (510) 622-2621
LICENSING EVALUATOR NAME: Catherine Lin	TELEPHONE: 510-622-2053
LICENSING EVALUATOR SIGNATURE:	DATE: 02/06/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/06/2023

LIC9099 (FAS) - (06/04)

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