019201129-9-30-2022-15-AS-KHOS-CKALRC-20221017085857

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 019201129
Report Date: 09/30/2022
Date Signed: 09/30/2022 09:24:06 AM

Unfounded

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
E BAY DELTA AC/SC, 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
02/15/2022 and conducted by Evaluator Catherine Lin

PUBLIC

COMPLAINT CONTROL NUMBER: 15-AS-20220215153035

FACILITY NAME:	CONNECTED LIVING OAKLAND		FACILITY NUMBER:	019201129
ADMINISTRATOR:	TRAIL, SARA		FACILITY TYPE:	740
ADDRESS:	1724 FILBERT ST		TELEPHONE:	(925) 826-6830
CITY:	OAKLAND	STATE: CA	ZIP CODE:	94607
CAPACITY:	3	CENSUS: 0	DATE:	09/30/2022
		ANNOUNCED	TIME BEGAN:	09:00 AM
MET WITH:	SARA TRAIL, Administrator		TIME COMPLETED:	09:40 AM

ALLEGATION(S):

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Facility does not have enough food for residents in care
Resident had an altercation with another resident in the home
Staff spoke inappropriately to resident
Staff did not safeguard resident's personal property
Staff left residents unattended
Staff yelled at residents
Staff did not allow resident to eat

INVESTIGATION FINDINGS:

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On 9/30/22 at 9:00am, Licensing Program Analyst (LPA) Catherine Lin conducted an announced subsequent complaint investigation regarding the above allegations and delivered investigation findings. LPA met with Administrator and explained the purpose of the visit.

Facility does not have enough food for residents in care – Unfounded
The Department has investigated this allegation and per record review and interviews found that the current census in facility was zero. There was no requirement to maintain adequate food supply in facility with zero census. During the subject time period, there were 2 individuals residing at the facility. It was found that R2 (subject of the complaint) was a general renter not receiving any services; and R1 and been accidentally placed at the facility by another agency (Family Home Agency), and was immediately transferred when it learned that the facility is an RCFE. Neither individual was jurisdictional to CCLD.

Continue on LIC9099-C (page 1)

Unfounded

Estimated Days of Completion:

SUPERVISORS NAME: Bennett Fong
LICENSING EVALUATOR NAME: Catherine Lin
LICENSING EVALUATOR SIGNATURE:	DATE: 09/30/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/30/2022

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 3

Control Number 15-AS-20220215153035

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
E BAY DELTA AC/SC, 1515 CLAY STREET, STE. 310
OAKLAND, CA 94612

FACILITY NAME: CONNECTED LIVING OAKLAND	FACILITY NUMBER: 019201129
	VISIT DATE: 09/30/2022

NARRATIVE

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Resident had an altercation with another resident in the home – Unfounded
The Department has investigated this allegation and per record review and interviews found that R1 was referred by Family Home Agency (FHA) which was contracted with the Mentor Network. R1’s social worker W1 had no knowledge that the facility had been licensed by CCL, and W1 moved R1 to an appropriate facility. R2 was a non-resident who was found to be a general renter of the facility. It had been alleged that R2 had been subjected to an assault by R1, however, it has been found that neither individual was jurisdictional to CCLD.

Staff spoke inappropriately to resident – Unfounded
The Department has investigated this allegation and per record review and interviews found that R2 (subject to this complaint) was a general renter and not an admission to the licensed facility. Staff denied speaking inappropriately to R2 with no witnesses identified, and R2 was not jurisdictional to CCLD.

Staff did not safeguard resident’s personal property – Unfounded
The Department has investigated this allegation and per record review and interviews found that R2 (subject to this complaint) was a general renter and not an admission to the licensed facility. Staff denied holding any personal belongings of R2, none were found at the facility during investigation, and there were no identified witnesses – in addition to R2 not being jurisdictional to CCLD.

Staff left residents unattended – Unfounded
The Department has investigated this allegation and per record review and interviews found that R2 (subject to this complaint) was a general renter and not an admission to the licensed facility. The facility was under no obligation to supervise R2, and R2 was not jurisdictional to CCLD.

Staff yelled at residents – Unfounded
The Department has investigated this allegation and per record review and interviews found that while staff denied yelling at the residents – with no identified witnesses – R2 (subject to this complaint) and R1 were not jurisdictional to CCLD.

Continue on LIC9099-C (page 2)

SUPERVISORS NAME: Bennett Fong
LICENSING EVALUATOR NAME: Catherine Lin
LICENSING EVALUATOR SIGNATURE:	DATE: 09/30/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/30/2022

LIC9099 (FAS) - (06/04)

Page: 2 of 3

Control Number 15-AS-20220215153035

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
E BAY DELTA AC/SC, 1515 CLAY STREET, STE. 310
OAKLAND, CA 94612

FACILITY NAME: CONNECTED LIVING OAKLAND	FACILITY NUMBER: 019201129
	VISIT DATE: 09/30/2022

NARRATIVE

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Staff did not allow resident to eat – Unfounded
The Department has investigated this allegation and per record review and interviews found that R2 (subject to this complaint) was a general renter and not an admission to the licensed facility. Therefore, the facility was under no obligation to provide food per Title 22 and R2 was not jurisdictional to CCLD.

The Department has investigated the complaint alleging the above complaint allegations and have found that the complaint was UNFOUNDED, meaning that the allegations are false, could not have happened and/or is without a reasonable basis.

No deficiency cited. Exit interview conducted with Administrator and a copy of this report provided.

(page 3, ended)

SUPERVISORS NAME: Bennett Fong
LICENSING EVALUATOR NAME: Catherine Lin
LICENSING EVALUATOR SIGNATURE:	DATE: 09/30/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/30/2022

LIC9099 (FAS) - (06/04)

Page: 3 of 3