075600352-4-24-2024-15-AS-HHUL-D4UMVF-20240501095636

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 075600352
Report Date: 04/24/2024
Date Signed: 04/24/2024 02:35:29 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
OAKLAND ASC, 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
12/20/2022 and conducted by Evaluator James Sampair

PUBLIC

COMPLAINT CONTROL NUMBER: 15-AS-20221220103745

FACILITY NAME:	ATRIA WALNUT CREEK		FACILITY NUMBER:	075600352
ADMINISTRATOR:	FREETH, JEFFREY		FACILITY TYPE:	740
ADDRESS:	1400 MONTEGO		TELEPHONE:	(925) 938-6611
CITY:	WALNUT CREEK	STATE: CA	ZIP CODE:	94598
CAPACITY:	200	CENSUS:	DATE:	04/24/2024
		UNANNOUNCED	TIME BEGAN:	02:00 PM
MET WITH:	Executive Director Kelli Greene		TIME COMPLETED:	03:00 PM

ALLEGATION(S):

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Staff neglect resulted in resident sustaining a fracture

INVESTIGATION FINDINGS:

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On 4/24/2024 at 2:00 PM, Licensing Program Analyst (LPA) J. Sampair arrived unannounced to deliver findings on the allegation above. The LPA informed Executive Director (ED) Kelli Greene of the reason for the visit.

The Department's investigation included, but was not limited to, interviews with current and former staff, residents, and the reporting party. The Department obtained and reviewed Resident R1’s records from the facility, hospital medical records, Walnut Creek Police Department records, Contra Costa County Fire Protection District records, Emergency Medical Services (EMS) records, and 911 audio call records from 12/17/2022.

Report Continues on LIC9099-C

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Harpreet Humpal	TELEPHONE: (510) 529-9416
LICENSING EVALUATOR NAME: James Sampair	TELEPHONE: (510) 286-4201
LICENSING EVALUATOR SIGNATURE:	DATE: 04/24/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/24/2024

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-20221220103745

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
OAKLAND ASC, 1515 CLAY STREET, STE. 310
OAKLAND, CA 94612

FACILITY NAME: ATRIA WALNUT CREEK	FACILITY NUMBER: 075600352
	VISIT DATE: 04/24/2024

NARRATIVE

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...Report Continued from LIC9099

The complaint alleges that staff neglect resulted in resident sustaining a fracture.

On 5/19/2022, the Reporting Party (RP) stated that Resident 1 (R1) was independent, did not need help with anything, and was able to walk on her own without any assistance, nor had R1 complained of being mistreated at the facility.

When interviewed about independent living Resident R1's fall on 12/17/2022, former Assistant Executive Director Jeffrey Freeth and 5 current and former staff members stated that the fall was unwitnessed. According to facility records and statements by staff, R1 had not had any falls at the facility before her 12/17/2022 fall, nor was R1 deemed to be a fall risk according to the assessment performed at the facility on 6/18/2022.

Although the allegations may have happened, or are valid, there is not a preponderance of evidence to prove them; therefore, the allegations are UNSUBSTANTIATED.

No citations issued during visit.

Exit interview conducted with ED. Appeal Rights and a copy of this report provided.

SUPERVISOR'S NAME: Harpreet Humpal	TELEPHONE: (510) 529-9416
LICENSING EVALUATOR NAME: James Sampair	TELEPHONE: (510) 286-4201
LICENSING EVALUATOR SIGNATURE:	DATE: 04/24/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/24/2024

LIC9099 (FAS) - (06/04)

Page: 2 of 4

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
OAKLAND ASC, 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
12/20/2022 and conducted by Evaluator James Sampair

PUBLIC

COMPLAINT CONTROL NUMBER: 15-AS-20221220103745

FACILITY NAME:	ATRIA WALNUT CREEK		FACILITY NUMBER:	075600352
ADMINISTRATOR:	FREETH, JEFFREY		FACILITY TYPE:	740
ADDRESS:	1400 MONTEGO		TELEPHONE:	(925) 938-6611
CITY:	WALNUT CREEK	STATE: CA	ZIP CODE:	94598
CAPACITY:	200	CENSUS:	DATE:	04/24/2024
		UNANNOUNCED	TIME BEGAN:	02:00 PM
MET WITH:	Executive Director Kelli Greene		TIME COMPLETED:	03:00 PM

ALLEGATION(S):

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9

Facility staff did not seek timely medical attention for resident.

INVESTIGATION FINDINGS:

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5
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7
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13

On 4/24/2024 at 1:00 PM, Licensing Program Analyst (LPA) J. Sampair arrived unannounced to deliver findings on the allegation above. The LPA informed Executive Director (ED) Kelli Greene of the reason for the visit.

The Department's investigation included, but was not limited to, interviews with current and former staff, residents, and the reporting party. The Department obtained and reviewed Resident R1’s records from the facility, hospital medical records, Walnut Creek Police Department records, Contra Costa County Fire Protection District records, Emergency Medical Services (EMS) records, and 911 audio call records from 12/17/2022.

Report Continues on LIC9099-C

Unfounded

Estimated Days of Completion:

SUPERVISOR'S NAME: Harpreet Humpal	TELEPHONE: (510) 529-9416
LICENSING EVALUATOR NAME: James Sampair	TELEPHONE: (510) 286-4201
LICENSING EVALUATOR SIGNATURE:	DATE: 04/24/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/24/2024

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 4

Control Number 15-AS-20221220103745

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
OAKLAND ASC, 1515 CLAY STREET, STE. 310
OAKLAND, CA 94612

FACILITY NAME: ATRIA WALNUT CREEK	FACILITY NUMBER: 075600352
	VISIT DATE: 04/24/2024

NARRATIVE

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...Report Continued from LIC9099

The complaint alleges that facility staff did not seek timely medical attention for resident.

When interviewed about independent living Resident R1's unwitnessed fall on 12/17/2022, 5 current and former staff members, as well as former Assistant Executive Director Jeffrey Freeth, stated that they sought medical attention for R1 immediately after being found. A review of the Walnut Creek Police Department (WCPD) report and their 911 audio call on 12/17/2022 showed that R1 was found by facility staff at 12:00 PM. At 12:01 PM, WCPD were called by facility staff. At 12:02 PM, the ambulance was dispatched. The ambulance arrived at the facility at 12:07 PM and R1 transported to the hospital at 12:27 PM.

Based on the data collected, the allegation is false, could not have happened, and/or is without a reasonable basis; therefore, the above allegation has been found to be UNFOUNDED.

No citations issued during visit.

Exit interview conducted with the ED. Appeal Rights and a copy of this report provided.

SUPERVISOR'S NAME: Harpreet Humpal	TELEPHONE: (510) 529-9416
LICENSING EVALUATOR NAME: James Sampair	TELEPHONE: (510) 286-4201
LICENSING EVALUATOR SIGNATURE:	DATE: 04/24/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/24/2024

LIC9099 (FAS) - (06/04)

Page: 4 of 4