019200873-8-10-2020-15-AS-HHUL-BSFVEE-20200813162209

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 019200873
Report Date: 08/10/2020
Date Signed: 08/10/2020 02:58:39 PM

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
09/26/2019 and conducted by Evaluator Treana White

PUBLIC

COMPLAINT CONTROL NUMBER: 15-AS-20190926145242

FACILITY NAME:	POINT AT ROCKRIDGE, THE		FACILITY NUMBER:	019200873
ADMINISTRATOR:	SAVOIE, DEBORAH		FACILITY TYPE:	740
ADDRESS:	4500 GILBERT STREET		TELEPHONE:	(510) 658-9266
CITY:	OAKLAND	STATE: CA	ZIP CODE:	94611
CAPACITY:	186	CENSUS: 135	DATE:	08/10/2020
		UNANNOUNCED	TIME BEGAN:	02:25 PM
MET WITH:	Kim Chua-Pilapil, Business Office Director		TIME COMPLETED:	03:00 PM

ALLEGATION(S):

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Resident sustained a head injury while in care
Staff did not seek medical attention for resident in a timely manner
Staff did not provide a safe environment for resident

INVESTIGATION FINDINGS:

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On 08/10/2020, Licensing Program Analyst (LPA) T. White called the facility to deliver the complaint findings for the above allegations. LPA spoke with Business Office Director, Kim Chua-Pilapil. LPA explained due to the present shelter in place order by the Governor, the notification of the complaint is being done over the phone.

During the course of investigation, LPA conducted interviews, collected documentation in relation to the complaint such as admission agreement, physicians report, incident reports, progress notes, and needs and service plan. This complaint was referred to IB and IB accepted this complaint as an assignment to collect medical records.

This agency has investigated the complaint alleging resident sustained a head injury while in care and staff did not provide a safe environment for resident.
Report continues on 9099C.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Harpreet Humpal	TELEPHONE: (510) 285-3928
LICENSING EVALUATOR NAME: Treana White	TELEPHONE: (510) 286-4201
LICENSING EVALUATOR SIGNATURE:	DATE: 07/27/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/27/2020

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-20190926145242

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: POINT AT ROCKRIDGE, THE	FACILITY NUMBER: 019200873
	VISIT DATE: 08/10/2020

NARRATIVE

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Based on information collected, it was concluded on 09/23/2019 Resident #2 (R2) pushed Resident #1 (R1). S2 stated they heard R1 scream and found her on the floor. Based on R2’s history at the time there were no acts of physical aggression that could have prevented this from occurring to begin with.

When R2 pushed R1, the facility contacted the family to inform them of R2’s behavior. R1 and R2 both returned to the facility on 09/25/2019. Based on S1’s interview, the facility reassessed R2 and requested the family provide a 1 on 1 caregiver. On 09/27/2019 a 1 on 1 caregiver was provided. However, the facility would provide a staff member to monitor R2, if a 1 on 1 caregiver was not available.

This agency has investigated the complaint alleging staff did not seek medical attention for resident in a timely manner.

Based on interview with S2, R2 pushed R1 and R1 was found on the floor by S2. R1 stated she wanted to speak to her Family Member #1 (FM1). S2 unsuccessfully contacted FM1. S2 then contacted Family Member #2 (FM2) and was informed that FM1 will be taking R1 to the hospital. However, there is no further evidence that indicates the facility did not seek medical attention for R1 in a timely manner.

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

Exit interview conducted with Business Office Director and a copy of report emailed to facility.

SUPERVISOR'S NAME: Harpreet Humpal	TELEPHONE: (510) 285-3928
LICENSING EVALUATOR NAME: Treana White	TELEPHONE: (510) 286-4201
LICENSING EVALUATOR SIGNATURE:	DATE: 07/27/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/27/2020

LIC9099 (FAS) - (06/04)

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