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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 071440541
Report Date: 11/26/2024
Date Signed: 11/26/2024 11:19:30 AM

Substantiated


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
10/25/2024 and conducted by Evaluator Lori Alexander-Washington
PUBLIC
COMPLAINT CONTROL NUMBER: 15-AS-20241025150045
FACILITY NAME:CHATEAU PLEASANT HILLFACILITY NUMBER:
071440541
ADMINISTRATOR:JOHN MCCRAWFACILITY TYPE:
740
ADDRESS:2726-2770 PLEASANT HILL RD.TELEPHONE:
(925) 935-1660
CITY:PLEASANT HILLSTATE: CAZIP CODE:
94523
CAPACITY:165CENSUS: 149DATE:
11/26/2024
UNANNOUNCEDTIME BEGAN:
10:25 AM
MET WITH:Jon McCraw, Executive DirectorTIME COMPLETED:
11:30 AM
ALLEGATION(S):
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Illegal eviction
INVESTIGATION FINDINGS:
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On 11/26/2024 at 10:25 AM, Licensing Program Analyst (LPA) L. Alexander conducted a subsequent visit and met with Executive Director (ED), Jon McCraw to deliver findings of above allegation. LPA explained the purpose of the visit with Executive Director.

During the course of the investigation, LPA interviewed witness (W) W1, three (3) staff (S) S1, S2 and S3 and resident (R) R1. LPA obtained and reviewed documents for R1 including Physician’s Report, Residence and Services Agreement, Individual Service Plans dated 08/30/23, 10/04/23, 12/10/23, 06/09/24, 08/01/24 and 09/30/24, staff documented observations, final notice and eviction letters, dated 01/24/24, 03/15/24 and 10/14/24.

LIC9099-C Continued
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Bennett Fong
LICENSING EVALUATOR NAME: Lori Alexander-Washington
LICENSING EVALUATOR SIGNATURE:

DATE: 11/26/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/26/2024
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 4
Control Number 15-AS-20241025150045
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: CHATEAU PLEASANT HILL
FACILITY NUMBER: 071440541
VISIT DATE: 11/26/2024
NARRATIVE
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Allegation: illegal eviction
Finding: Substantiated

On 10/30/2024, the LPA interviewed Witness (W1). W1 stated that Resident (R1) received a 30-day eviction notice dated 10/14/2024 from ED. Based on interview with W1, they denied having awareness of R1’s sexual behaviors. W1 stated that they had a phone conference with S4 around October 2023 regarding care needs for R1. W1 stated that the next formal care conference was on 06/03/2024 over the phone. W1 stated that they were informed by text message of the January 2024 incident where R1 verbalized sexually inappropriate things to an employee. W1 stated that during a phone call with ED on 10/14/24 that is when they were informed of the March 2024 incident. W1 also stated the ED admitted that they didn’t notify incident and W1 didn’t receive written notices. W1 stated that they never received copies of the letters that was given to R1 regarding warnings for making inappropriate sexual advancements to employees and residents.

On 11/01/2024, the LPA interviewed Staff, and Resident. S1 stated that R1 made inappropriate comments to them on two separate occasions. LPA interviewed R1 that admitted making inappropriate remarks to staff. On 11/11/2024, the LPA interviewed S2 that stated R1 made an inappropriate comment which was directed to them through a text message earlier this year on their work phone.





LIC9099-C Continued
SUPERVISORS NAME: Bennett Fong
LICENSING EVALUATOR NAME: Lori Alexander-Washington
LICENSING EVALUATOR SIGNATURE:

DATE: 11/26/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/26/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 4
Control Number 15-AS-20241025150045
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: CHATEAU PLEASANT HILL
FACILITY NUMBER: 071440541
VISIT DATE: 11/26/2024
NARRATIVE
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LIC9099-C Continued

Based on record review, the eviction letter provided to R1 does not meet the requirements of eviction notices under Health and Safety 1569.683. The failure to notify R1’s responsible party the same day and mail a copy of eviction letter to responsible party. Mail or fax the eviction letter and a written report to the Department within 5 (five) days of notice. Licensee failed to do a new Needs and Services Plan with new behaviors. The eviction letter lacked alternative housing resources, by giving more than 1 option. The licensee is responsible in assisting the resident with relocation and not put the responsibility on the resident for their own placement. Also, there was the incorrect address for Empowering Aging (local ombudsman office). Failure to include information for State Long Term Care Ombudsman for filing a complaint.

Based on LPA’s observations and interviews conducted and record reviews, the preponderance of evidence standard has been met, therefore the above allegation is found to be SUBSTANTIATED. California Code of Regulations (Title 22, Division 6, Chapter 8), is being cited on the attached LIC 9099D.

Exit interview conducted. Appeal Rights and a copy of this report provided.
SUPERVISORS NAME: Bennett Fong
LICENSING EVALUATOR NAME: Lori Alexander-Washington
LICENSING EVALUATOR SIGNATURE:

DATE: 11/26/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/26/2024
LIC9099 (FAS) - (06/04)
Page: 3 of 4
Control Number 15-AS-20241025150045
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: CHATEAU PLEASANT HILL
FACILITY NUMBER: 071440541
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/26/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Request Denied
Type B
11/27/2024
Section Cited
HSC
1569.683
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§1569.683 Eviction notices; reasons for eviction contents; service
(a) In addition to complying with other applicable regulations, a licensee of a residential care facility for the elderly who sends a notice of eviction to a resident shall set forth in the notice to quit the reasons relied upon for the eviction, with specific facts to permit determination of the date, place, witnesses, and circumstances concerning those reasons. In addition, the notice to quit shall include all of the following:
(1) The effective date of the eviction.
(2) Resources available to assist in identifying alternative housing and care options, including public and private referral services and case management organizations.
(3) Information about the resident's right to file a complaint with the department regarding the eviction, with the name, address, and telephone number of the nearest office of community care licensing and the State Ombudsman.
(4) The following statement: "In order to evict a resident who remains in the facility after the effective date of the eviction, the residential care facility for the elderly must file an unlawful detainer action in superior court and receive a written judgment
signed by a judge. If the facility pursues the unlawful detainer action, you must be served with a summons and complaint. You have the right to contest the eviction in writing and through a hearing."
(b) The licensee, in addition to either serving a 30-day notice, or seeking approval from the department and serving three days notice, on the resident, shall notify, or mail a copy of the notice to quit to, the resident's responsible person.

This requirement is not met as evidenced by:
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The Administrator will read the regulation and submit self-certification that it has been read, understood and they will comply going forward to CCLD by POC due date. In addition, the licensee shall rescind the eviction, notify resident, responsible party, and issue legal notice if that is still licensee’s plan.
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Based on interview and record review the licensee did not comply with the section cited above in serving R1 with an appropriate eviction notice that did not contain all items required under regulation, which poses a potential health and safety and personal rights risk to persons in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISORS NAME: Bennett Fong
LICENSING EVALUATOR NAME: Lori Alexander-Washington
LICENSING EVALUATOR SIGNATURE:

DATE: 11/26/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/26/2024
LIC9099 (FAS) - (06/04)
Page: 4 of 4