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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 075600335
Report Date: 11/24/2020
Date Signed: 11/24/2020 05:05:20 PM



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
10/21/2020 and conducted by Evaluator Jacob Williams
PUBLIC
COMPLAINT CONTROL NUMBER: 15-AS-20201021114053
FACILITY NAME:REUTLINGER COMMUNITY, THEFACILITY NUMBER:
075600335
ADMINISTRATOR:ZIMMER, JAYFACILITY TYPE:
741
ADDRESS:4000 CAMINO TASSAJARATELEPHONE:
(925) 648-2800
CITY:DANVILLESTATE: CAZIP CODE:
94526
CAPACITY:120CENSUS: 76DATE:
11/24/2020
UNANNOUNCEDTIME BEGAN:
04:45 PM
MET WITH:Rammy KaurTIME COMPLETED:
05:06 PM
ALLEGATION(S):
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9
Facility failed to adhere to local infectious disease control
INVESTIGATION FINDINGS:
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On 11/24/2020, LPA Jacob Williams conducted an unannounced continuing complaint visit meeting with Rammy Kaur. Due to the State's current shelter in place order, this visit was conducted by telephone.

On 10/22/2020, LPA interviewed S3 and on 11/6, interviewed S8. On 10/27 the RP provided a screen shot photo of S3 with his mask on but pulled down to his chin; and on 10/29, the RP provided screen shot photo of S8 with a mask on but pulled down to her chin. During interviews, both S3 and S8 acknowledged the photos as being of them while inside the facility. County health order requires that staff have on face coverings at all times.

Continued on LIC9099-C
Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Julio MontesTELEPHONE: (510) 286-0518
LICENSING EVALUATOR NAME: Jacob WilliamsTELEPHONE: (510) 286-4201
LICENSING EVALUATOR SIGNATURE:

DATE: 11/24/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/24/2020
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 5
Control Number 15-AS-20201021114053
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: REUTLINGER COMMUNITY, THE
FACILITY NUMBER: 075600335
VISIT DATE: 11/24/2020
NARRATIVE
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Page 2

The Department has investigated this complaint, and based on interviews conducted and screen shot photos received, the preponderance of evidence standard has been met, therefore the above allegation is found to be Substantiated. Deficiency cited per California Code of Regulations, Title 22, Division 6 and Chapter 8, on the attached LIC 9099D. Failure to provide proof of correction by the due date may result in civil penalties.

Exit interview conducted and appeal rights provided.
SUPERVISOR'S NAME: Julio MontesTELEPHONE: (510) 286-0518
LICENSING EVALUATOR NAME: Jacob WilliamsTELEPHONE: (510) 286-4201
LICENSING EVALUATOR SIGNATURE:

DATE: 11/24/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/24/2020
LIC9099 (FAS) - (06/04)
Page: 2 of 5
Control Number 15-AS-20201021114053
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: REUTLINGER COMMUNITY, THE
FACILITY NUMBER: 075600335
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/24/2020
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
12/01/2020
Section Cited
CCR
87468.1(a)(2)
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To be accorded safe, healthful... accommodations. This requirement was not met as evidenced by: LPA observed that 2 staff persons had not properly worn face coverings
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By POC date, facility will submit proof of in-house training with all staff, reiterating the importance of maintaining proper donning of face coverings during the COVID pandemic.
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while providing care and supervision, in violation of government orders requiring the wearing of face coverings, which is a health & safety threat to residents in care.
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ILS
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HSC
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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.
SUPERVISOR'S NAME: Julio MontesTELEPHONE: (510) 286-0518
LICENSING EVALUATOR NAME: Jacob WilliamsTELEPHONE: (510) 286-4201
LICENSING EVALUATOR SIGNATURE:

DATE: 11/24/2020
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/24/2020
LIC9099 (FAS) - (06/04)
Page: 5 of 5
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
10/21/2020 and conducted by Evaluator Jacob Williams
PUBLIC
COMPLAINT CONTROL NUMBER: 15-AS-20201021114053

FACILITY NAME:REUTLINGER COMMUNITY, THEFACILITY NUMBER:
075600335
ADMINISTRATOR:ZIMMER, JAYFACILITY TYPE:
741
ADDRESS:4000 CAMINO TASSAJARATELEPHONE:
(925) 648-2800
CITY:DANVILLESTATE: CAZIP CODE:
94526
CAPACITY:120CENSUS: 76DATE:
11/24/2020
UNANNOUNCEDTIME BEGAN:
04:45 PM
MET WITH:Rammy KaurTIME COMPLETED:
05:06 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Facility failed to report to Responsible Party.
INVESTIGATION FINDINGS:
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On 11/24/2020, LPA Jacob Williams conducted an unannounced continuing complaint visit meeting with Rammy Kaur. Due to the State's current shelter in place order, this visit was conducted by telephone.

The Reporting Party (RP), as Responsible Party, informed CCLD that RP had not been informed when the facility identified a COVID-positive individual. During interview, S7 asserted that on 7/13/20 and 8/21/20, S7 spoke verbally with the RP to inform RP that COVID-positive individuals had been identified at the facility and that they required the RP’s consent to perform a test on R1. The facility produced progress notes for R1 indicating that the calls to the RP were made stating the above, and the line items on the progress notes...

Continued on LIC9099-C
Unfounded
Estimated Days of Completion:
SUPERVISOR'S NAME: Julio MontesTELEPHONE: (510) 286-0518
LICENSING EVALUATOR NAME: Jacob WilliamsTELEPHONE: (510) 286-4201
LICENSING EVALUATOR SIGNATURE:

DATE: 11/24/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/24/2020
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 3 of 5
Control Number 15-AS-20201021114053
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: REUTLINGER COMMUNITY, THE
FACILITY NUMBER: 075600335
VISIT DATE: 11/24/2020
NARRATIVE
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Page 2

...were signed by S7. The facility also produced a copy of an email communication with the RP dated 8/26/20 reflecting that facility had informed RP of a COVID-positive individual and requested consent for continual testing of R1. It was observed that RP responded to the email. The facility conducted mass testing following the receipt of positive results.

The Department has investigated this complaint and based on interviews conducted and records reviewed, the above allegation is Unfounded, meaning that the allegation is false, could not have happened, or is without a reasonable basis.

Exit interview conducted.
SUPERVISOR'S NAME: Julio MontesTELEPHONE: (510) 286-0518
LICENSING EVALUATOR NAME: Jacob WilliamsTELEPHONE: (510) 286-4201
LICENSING EVALUATOR SIGNATURE:

DATE: 11/24/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/24/2020
LIC9099 (FAS) - (06/04)
Page: 4 of 5