019200873-9-13-2024-15-AS-HHUL-D9HTM2-20240927145023

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 019200873
Report Date: 09/13/2024
Date Signed: 09/13/2024 06:01:51 PM

Substantiated

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
07/05/2023 and conducted by Evaluator Grace Luk

PUBLIC

COMPLAINT CONTROL NUMBER: 15-AS-20230705164320

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: 120	DATE:	09/13/2024
		UNANNOUNCED	TIME BEGAN:	11:40 AM
MET WITH:	Stephanie Brice, Executive Director		TIME COMPLETED:	06:20 PM

ALLEGATION(S):

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9

Staff handled residents in care in a rough manner

INVESTIGATION FINDINGS:

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On 9/13/2024 at 11:40AM, Licensing Program Analyst (LPA) G. Luk arrived unannounced to conduct complaint investigation and deliver findings in regards to the allegation above. LPA met with Executive Director, Stephanie Brice and informed her the reason for visit.

During the course of investigation, LPA interviewed 6 residents, 4 staff, and complainant. LPA obtained and reviewed documents including staff roster with contact numbers, staff schedule, physician's report, care plan, emergency information, care notes, incident reports, discharge documents, and staff termination documents.

Interview with staff revealed that two staff (S7 and S8) was rough with residents during ADL (Activities of Daily Living) care. S1 and S5 stated that after reviewing the safety-you system, it was observed that S7 cause a resident to fall on two different days without injuries. The two staff were either terminated or resigned.
(Continue on LIC9099C...)

Substantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Harpreet Humpal	TELEPHONE: (510) 285-3928
LICENSING EVALUATOR NAME: Grace Luk	TELEPHONE: (510) 286-4201
LICENSING EVALUATOR SIGNATURE:	DATE: 09/13/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/13/2024

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 5

Control Number 15-AS-20230705164320

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: 09/13/2024

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32	Based on LPA's information obtained during investigation, the preponderance of evidence standard has been met; therefore, the above allegation is found to be SUBSTANTIATED. California Code of Regulations, Title 22, are being cited on the attached LIC9099D. Exit interview conducted. A copy of this report and appeal rights provided.

SUPERVISOR'S NAME: Harpreet Humpal	TELEPHONE: (510) 285-3928
LICENSING EVALUATOR NAME: Grace Luk	TELEPHONE: (510) 286-4201
LICENSING EVALUATOR SIGNATURE:	DATE: 09/13/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/13/2024

LIC9099 (FAS) - (06/04)

Page: 2 of 5

Control Number 15-AS-20230705164320

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
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 09/13/2024

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 09/23/2024 Section Cited CCR 87468.1(a)(3)	1 2 3 4 5 6 7	Personal Rights of Residents in All Facilities. To be free from punishment, humiliation, intimidation, abuse, or other actions of a punitive nature... This requirement is not met as evidence by:	1 2 3 4 5 6 7	Executive Director has agreed to conduct training for staff and submit staff sign in sheet & materials to CCLD by POC date.
	8 9 10 11 12 13 14	Based on investigation, licensee did not comply with the section cited above by staff performing ADL care in a rough manner which poses a potential health and safety risk to the 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: Harpreet Humpal	TELEPHONE: (510) 285-3928
LICENSING EVALUATOR NAME: Grace Luk	TELEPHONE: (510) 286-4201
LICENSING EVALUATOR SIGNATURE:	DATE: 09/13/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/13/2024

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
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
07/05/2023 and conducted by Evaluator Grace Luk

PUBLIC

COMPLAINT CONTROL NUMBER: 15-AS-20230705164320

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: 120	DATE:	09/13/2024
		UNANNOUNCED	TIME BEGAN:	11:40 AM
MET WITH:	Stephanie Brice, Executive Director		TIME COMPLETED:	06:20 PM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Staff caused multiple injuries to residents in care
Staff do not provide adequate supervision to residents in care

INVESTIGATION FINDINGS:

1
2
3
4
5
6
7
8
9
10
11
12
13

On 9/13/2024 at 11:40AM, Licensing Program Analyst (LPA) G. Luk arrived unannounced to conduct complaint investigation and deliver findings in regards to the allegations above. LPA met with Executive Director, Stephanie Brice and informed her the reason for visit.

During the course of investigation, LPA interviewed 6 residents, 4 staff, and complainant. LPA obtained and reviewed documents including staff roster with contact numbers, staff schedule, physician's report, care plan, emergency information, care notes, incident reports, discharge documents, and staff termination documents.

Staff caused multiple injuries to residents in care
Interview with residents revealed that residents have not witness staff causing injuries to residents. Interview with staff indicated that R3 had an unwitnessed fall which resulted in injuries. However, staff stated that R3's injuries were not caused by staff.
(Continue on LIC9099C...)

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Harpreet Humpal	TELEPHONE: (510) 285-3928
LICENSING EVALUATOR NAME: Grace Luk	TELEPHONE: (510) 286-4201
LICENSING EVALUATOR SIGNATURE:	DATE: 09/13/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/13/2024

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-20230705164320

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: 09/13/2024

NARRATIVE

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Staff do not provide adequate supervision to residents in care
Interview with residents revealed that staff would always respond to call buttons and staff are available when needed. Interview with staff indicated facility has been using a third party agency to provide additional caregivers as needed. S1 stated there are a set of caregivers and med techs for Assisted Living and Memory Care separately for AM shift, PM shift, and NOC shift.

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

Exit interview conducted. A copy of this report provided.

SUPERVISOR'S NAME: Harpreet Humpal	TELEPHONE: (510) 285-3928
LICENSING EVALUATOR NAME: Grace Luk	TELEPHONE: (510) 286-4201
LICENSING EVALUATOR SIGNATURE:	DATE: 09/13/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/13/2024

LIC9099 (FAS) - (06/04)

Page: 5 of 5