019200874-3-9-2021-15-AS-KHOS-BYXQVK-20210309113028

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, THE		FACILITY NUMBER:	019200874
ADMINISTRATOR:	MARTIN, CHERYL		FACILITY TYPE:	740
ADDRESS:	1440 40TH STREET		TELEPHONE:	(510) 594-8800
CITY:	EMERYVILLE	STATE: CA	ZIP CODE:	94608
CAPACITY:	175	CENSUS: 78	DATE:	09/16/2020
		UNANNOUNCED	TIME BEGAN:	03:00 PM
MET WITH:	Katherine Foos, Assisted Living Program Director		TIME 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 Montes	TELEPHONE: (510) 622-2610
LICENSING EVALUATOR NAME: Bennett Fong	TELEPHONE: (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 Taggart	TELEPHONE: (510) 622-2610
LICENSING EVALUATOR NAME: Jason Hamilton	TELEPHONE: (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