019201039-8-27-2024-15-AS-KHOS-D97HYD-20240917063635

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 019201039
Report Date: 08/27/2024
Date Signed: 08/27/2024 05:26:23 PM

Unsubstantiated

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
03/18/2024 and conducted by Evaluator Grace Luk

PUBLIC

COMPLAINT CONTROL NUMBER: 15-AS-20240318092143

FACILITY NAME:	CAREFIELD PLEASANTON		FACILITY NUMBER:	019201039
ADMINISTRATOR:	SINGH, PARVEEN		FACILITY TYPE:	740
ADDRESS:	4115 MOHR AVE.		TELEPHONE:	(925) 461-8409
CITY:	PLEASANTON	STATE: CA	ZIP CODE:	94566
CAPACITY:	82	CENSUS: 45	DATE:	08/27/2024
		UNANNOUNCED	TIME BEGAN:	03:30 PM
MET WITH:	Eunice O'Farrell, Executive Director		TIME COMPLETED:	05:40 PM

ALLEGATION(S):

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Facility not allowing family members to visit resident.
Facility not allowing resident to receive phone calls.

INVESTIGATION FINDINGS:

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On 8/27/2024 at 3:30PM, Licensing Program Analysts (LPAs) G. Luk and P. Manalo arrived unannounced to conduct complaint investigation and deliver complaint findings for the allegations above. LPAs met with Executive Director, Eunice O'Farrell and explained to her the reason for the visit.

During the investigation, LPA G. Luk interviewed 3 residents, 2 staff, and complainant. LPAs reviewed and obtained documents including staff roster with contact information, physician's report, emergency information, POA documents, email correspondence, visitation records, and phone call records

Facility not allowing family members to visit resident.
Interview with residents revealed that family members does visit residents at the facility. After reviewing resident visitor logs, LPAs observed that residents are receiving visitors. Interview with staff indicated that resident (R1) had visitors after admission to the facility.
(Continue on 9099C...)

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: 08/27/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/27/2024

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-20240318092143

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: CAREFIELD PLEASANTON	FACILITY NUMBER: 019201039
	VISIT DATE: 08/27/2024

NARRATIVE

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Facility not allowing resident to receive phone calls.
Interview with staff and residents revealed that residents are receiving phone calls. After reviewing phone logs, LPAs observed resident (R1) was receiving phone calls.

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: 08/27/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/27/2024

LIC9099 (FAS) - (06/04)

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