<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 019200874
Report Date: 09/16/2020
Date Signed: 03/09/2021 11:29:26 AM



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
03/06/2020 and conducted by Evaluator Jason Hamilton
PUBLIC
COMPLAINT CONTROL NUMBER: 15-AS-20200306161114
FACILITY NAME:WATERMARK BY THE BAY, THEFACILITY NUMBER:
019200874
ADMINISTRATOR:MARTIN, CHERYLFACILITY TYPE:
740
ADDRESS:1440 40TH STREETTELEPHONE:
(510) 594-8800
CITY:EMERYVILLESTATE: CAZIP CODE:
94608
CAPACITY:175CENSUS: 78DATE:
09/16/2020
UNANNOUNCEDTIME BEGAN:
03:00 PM
MET WITH:Katherine Foos, Assisted Living Program DirectorTIME COMPLETED:
03:17 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Sexual abuse.
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
On 09/16/20 at 3:00pm, LPA J. Hamilton contacted Katherine Foos, Assisted Living Program Director, in order to deliver findings for this complaint. Due to the Governor's shelter-in-place order, this meeting took place via videoconference.

On the allegation of sexual abuse, the Department obtained facility records, resident (R1) records, conducted interviews, and reviewed reports by Alameda County Adult Protective Services and the Emeryville Police Department.

Based on interviews conducted, both facility staff (S2) and the individual referred to here as witness (W1) stated that W1 is not a facility employee but is employed by an outside agency. S2 stated that this agency was chosen by a family member representing R1, via referral by R1's physician. S2 stated that the facility is required to present a selection of three agencies that may provide the type of therapy R1 was in need of. S2 confirmed that while the agency that employed W1 was one of the three options presented, the choice to use this agency was ultimately not the facility's.

Continued on 9099-C
Unfounded
Estimated Days of Completion:
SUPERVISOR'S NAME: Julio MontesTELEPHONE: (510) 622-2610
LICENSING EVALUATOR NAME: Bennett FongTELEPHONE: (510) 622-2647
LICENSING EVALUATOR SIGNATURE:

DATE: 09/16/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/16/2020
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 2
Control Number 15-AS-20200306161114
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: WATERMARK BY THE BAY, THE
FACILITY NUMBER: 019200874
VISIT DATE: 09/16/2020
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
W1 denied the allegation, stated the therapy with R1 entailed no contact below the waist, no removal of clothing, and was limited to upper body and balance exercises.

Per the Emeryville Police Department's report, R1, who has cognitive deficiencies due to a stroke, did not recall the incident, and told the investigating officer that "it may have just been a dream."

Based on interviews conducted, reports and records reviewed, the Department has investigated the allegation and found that it is unfounded, meaning that the allegation was false, could not have happened and/or is without reasonable basis. We have therefore dismissed the complaint.

Exit interview conducted and a copy of this report will be provided to the facility by email.
SUPERVISOR'S NAME: Isaac TaggartTELEPHONE: (510) 622-2610
LICENSING EVALUATOR NAME: Jason HamiltonTELEPHONE: (510) 622-2647
LICENSING EVALUATOR SIGNATURE:

DATE: 09/16/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/16/2020
LIC9099 (FAS) - (06/04)
Page: 2 of 2