019201182-8-1-2024-15-AS-KHOS-D9FKWD-20240925081546

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 019201182
Report Date: 08/01/2024
Date Signed: 08/01/2024 12:03:39 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
07/30/2024 and conducted by Evaluator Kelly Nguyen

COMPLAINT CONTROL NUMBER: 15-AS-20240730151503

FACILITY NAME:	LAKE PARK SENIOR LIVING		FACILITY NUMBER:	019201182
ADMINISTRATOR:	MEDINI, ROZA		FACILITY TYPE:	741
ADDRESS:	1850 ALICE STREET		TELEPHONE:	(510) 835-5511
CITY:	OAKLAND	STATE: CA	ZIP CODE:	94612
CAPACITY:	275	CENSUS: 114	DATE:	08/01/2024
		UNANNOUNCED	TIME BEGAN:	08:30 AM
MET WITH:	Kenia Tobete, Activity Director		TIME COMPLETED:	12:35 PM

ALLEGATION(S):

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Staff did not provide safe transportation for resident

INVESTIGATION FINDINGS:

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On this day, 8/1/2024, at 8:30 a.m., Licensing Program Analyst (LPA) K. Nguyen arrived unannounced to investigate the above allegation. LPA met with Front Desk, Brooklyn Manuel. LPA asked to speak with Executive Director but were told that she will not be in until the following week. LPA asked to speak to the next point person Business Office Manager (BOM), who was not available front desk left a message. LPA was greeted by the activity director, Kenia Tobete. LPA explained the purpose of the visit after getting verbal apporval from pointed person for Kenia to sign the report.

It was alleged that Staff did not provide safe transportation for resident.

Report continued on LIC 9099C…

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Bennett Fong	TELEPHONE: (510) 725-7919
LICENSING EVALUATOR NAME: Kelly Nguyen	TELEPHONE: (510) 915-8702
LICENSING EVALUATOR SIGNATURE:	DATE: 08/01/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/01/2024

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-20240730151503

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: LAKE PARK SENIOR LIVING	FACILITY NUMBER: 019201182
	VISIT DATE: 08/01/2024

NARRATIVE

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During investigation LPA obtained copies of resident roster, transportation planner in the month of May till present, and confirmation receipt from private company that facility call to arranged transportation to residents that are wheelchair bond. LPA interviewed residents that identify by activity director who are wheelchair bond. 2 out of 3 residents stated that facility staff do not transport them in the facility minivan nor the 14-passenger van, because there is no way our wheelchair can get in. LPA attempted to interview R1 but R1 didn’t want to be interview. LPA interviews staffs. 5 out of 5 staff stated that they have not transport any residents or have seen any staff that transport residents that are wheelchair bond on the mini-van nor the 14 passenger’s van. 5 out of 5 stated that residents that are wheelchair bond cannot get on to the mini-van or the 14 passenger’s van, because it’s impossible to get the wheelchair in for both van. S2 stated that S2 arranged all the transportation during the time that the main bus that transport wheelchair bond break down. S2 arranged transportation from residents who is wheelchair bond from their sister facility or the private company that specialized in transferring wheelchair bond.

Based on information gathered, the allegation is closed as unsubstantiated. A finding that a complaint is unsubstantiated means that although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violation occurred.

Exit interview conducted and copy of this report provided.

SUPERVISOR'S NAME: Bennett Fong	TELEPHONE: (510) 725-7919
LICENSING EVALUATOR NAME: Kelly Nguyen	TELEPHONE: (510) 915-8702
LICENSING EVALUATOR SIGNATURE:	DATE: 08/01/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/01/2024

LIC9099 (FAS) - (06/04)

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