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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 019200873
Report Date: 07/12/2023
Date Signed: 07/12/2023 02:53:17 PM


Document Has Been Signed on 07/12/2023 02:53 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1515 CLAY STREET, STE. 310
OAKLAND, CA 94612



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: 134DATE:
07/12/2023
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH:Stephanie Brice, AdministratorTIME COMPLETED:
01:45 PM
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On 7/12/23 at 1:00 p.m., Licensing Program Analyst (LPA) Greg Clark arrived unannounced to conduct a case management visit due to receiving a death report with incorrect dates. LPA met with Stephanie Brice, Administrator and explained the purpose of the visit.

LPA interviewed Resident Care Director (RCD) who wrote the death report. The death report stated R1 was found unresponsive on May 31st in her apartment by care staff. R1 was transported to Kaiser Oakland. The report then states R1's responsible party called the facility on May 1st to report R1 passed away due to a cerebral stroke. The correct date should have been June 1,2023.

LPA reviewed R1's file: move-in date 1/28/22 with a diagnosis of TRA (transient ischemic attack), a DNR dated 2/16/22. R1 was categorized as independent. No other outstanding health conditions or concerns were noted.

LPA advised RCD to submit a corrected death report. Corrected report received during visit.

No deficiencies cited during visit. Exit interview conducted and a copy of this report provided.
SUPERVISOR'S NAME: Yvonne Flores-LariosTELEPHONE: (510) 286-0517
LICENSING EVALUATOR NAME: Gregory ClarkTELEPHONE: 510-285-3927
LICENSING EVALUATOR SIGNATURE:
DATE: 07/12/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/12/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
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