075600352-7-27-2022-15-AS-KHOS-CMKMMD-20221229084348

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 075600352
Report Date: 07/27/2022
Date Signed: 07/27/2022 05:57:19 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
04/27/2022 and conducted by Evaluator James Sampair

COMPLAINT CONTROL NUMBER: 15-AS-20220427143550

FACILITY NAME:	ATRIA WALNUT CREEK		FACILITY NUMBER:	075600352
ADMINISTRATOR:	TUDDA, BARBARA		FACILITY TYPE:	740
ADDRESS:	1400 MONTEGO		TELEPHONE:	(925) 938-6611
CITY:	WALNUT CREEK	STATE: CA	ZIP CODE:	94598
CAPACITY:	200	CENSUS: 125	DATE:	07/27/2022
		UNANNOUNCED	TIME BEGAN:	09:15 AM
MET WITH:	Assistant Executive Director Jeffrey Freeth and Resident Services Director Leash Brown		TIME COMPLETED:	02:00 PM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Resident caused injuries to other residents in care.

INVESTIGATION FINDINGS:

1
2
3
4
5
6
7
8
9
10
11
12
13

On 7/27/2022, Licensing Program Analyst (LPA) J. Sampair arrived unannounced and met with Jeff Freeth and Leash Brown and explained the purpose of this follow up visit.

Over the course of this investigation, LPA has reviewed records and conducted interviews of staff and residents. From the data collected, the LPA discovered that the facility had properly attended to the rights and needs and safety issues of all residents when resident R1 had accidentally caused minor injuries to other residents, supporting R1 in safely using the scooter and causing no more reported injuries since 4/9/22.

Based on the interviews conducted and the records reviewed, the preponderance of evidence standard has not been met, therefore the allegation is found to be UNSUBSTANTIATED, meaning that although the allegation may have happened or is valid, there is not a preponderance of evidence to prove it did or did not occur.

Exit interview with Assistant Executive Director Jeffrey Freeth and Resident Services Director Leash Brown was conducted and a copy of this report provided.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Harpreet Humpal	TELEPHONE: (510) 285-3928
LICENSING EVALUATOR NAME: James Sampair	TELEPHONE: (510) 286-4201
LICENSING EVALUATOR SIGNATURE:	DATE: 07/27/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/27/2022

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