071440541-11-19-2025-15-AS-BFOG-DNLUHQ-20251120143620

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 071440541
Report Date: 11/19/2025
Date Signed: 11/19/2025 03:56:46 PM

Unsubstantiated

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
07/07/2025 and conducted by Evaluator Lori Alexander-Washington

PUBLIC

COMPLAINT CONTROL NUMBER: 15-AS-20250707103621

FACILITY NAME:	CHATEAU PLEASANT HILL		FACILITY NUMBER:	071440541
ADMINISTRATOR:	JOHN MCCRAW		FACILITY TYPE:	740
ADDRESS:	2726-2770 PLEASANT HILL RD.		TELEPHONE:	(925) 935-1660
CITY:	PLEASANT HILL	STATE: CA	ZIP CODE:	94523
CAPACITY:	165	CENSUS: 139	DATE:	11/19/2025
		UNANNOUNCED	TIME BEGAN:	03:15 PM
MET WITH:	Jon McCraw, Executive Director		TIME COMPLETED:	04:00 PM

ALLEGATION(S):

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Staff are not following residents incontinent plan
Staff are not following residents special diet
Staff did not ensure residents hopital bed was set up for resident

INVESTIGATION FINDINGS:

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On 11/19/2025 at 3:15 PM, 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 ED.

During the investigation LPAs interviewed Staff (S) and Residents (R). The following documents were obtained: Resident's (R1's) Admissions Agreement, Physician's Report, Face Sheet, Continence Care Resident Roster, Staff Roster, Monthly Task Logs (05/25, 06/25, 07/25), Service Plan Detail (05/08/25), Hospice Care Plan Calendar, Hospice Care Notes (Started 04/27/25), Hospice IDG Comprehensive Assessment and Plan of Care Update Report (05/21/2025), Progress Notes, "notes for family" (07/13/2025), Pleasant Hill Police Incident Report #2507070026 (07/07/2025) and DME order delivery receipt (04/25/25).

LIC9099-C Continued...

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Bennett Fong
LICENSING EVALUATOR NAME: Lori Alexander-Washington
LICENSING EVALUATOR SIGNATURE:	DATE: 11/19/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/19/2025

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-20250707103621

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: 11/19/2025

NARRATIVE

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LIC9099-C (Page 2)

Allegation: Staff are not following resident’s incontinent plan
Finding: Unsubstantiated

LPA reviewed R1’s Service Plan dated 05/08/25, which indicates that R1 requires Continence Care six (6) times per day, with care partners completing brief checks every two (2) hours to ensure R1 remains clean and dry.

Review of chart notes dated 07/13/25 – 07/17/25 indicates that care partners were performing checks every two hours to reposition R1 and ensure they were clean and dry, as documented. In addition, the staffing schedule confirmed caregiver coverage for the required six-times-per-day continence care schedule.

Allegation: Staff are not following resident’s special diet
Finding: Unsubstantiated

LPA reviewed R1’s Physician’s Order dated 07/02/25, which prescribes a pureed diet with thin liquids.

Review of chart notes dated 07/13/25 – 07/17/25 reflects that staff offered R1 foods and liquids consistent with the ordered diet, including soup, yogurt, pudding, mashed potatoes, Cream of Wheat, cranberry juice, and water. Documentation indicates that R1 would eat or drink at times and would occasionally refuse food, which is within resident rights.

LIC9099-C

SUPERVISORS NAME: Bennett Fong
LICENSING EVALUATOR NAME: Lori Alexander-Washington
LICENSING EVALUATOR SIGNATURE:	DATE: 11/19/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/19/2025

LIC9099 (FAS) - (06/04)

Page: 2 of 3

Control Number 15-AS-20250707103621

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: 11/19/2025

NARRATIVE

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LIC9099-C (Page 3)

Allegation: Staff did not ensure resident’s hospital bed was set up for resident
Finding: Unsubstantiated

S1 stated that once they knew that the mattress was delivered they put the mattress in place. LPA reviewed records that showed delivery of DME including mattress was completed on 04/25/25.

Although the allegations may have happened or is valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegations is UNSUBSTANTIATED.

Exit interview conducted and a copy of this report provided.

SUPERVISORS NAME: Bennett Fong
LICENSING EVALUATOR NAME: Lori Alexander-Washington
LICENSING EVALUATOR SIGNATURE:	DATE: 11/19/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/19/2025

LIC9099 (FAS) - (06/04)

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