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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 075600352
Report Date: 03/20/2024
Date Signed: 03/20/2024 06:21:14 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
03/14/2024 and conducted by Evaluator James Sampair
PUBLIC
COMPLAINT CONTROL NUMBER: 15-AS-20240314092013
FACILITY NAME:ATRIA WALNUT CREEKFACILITY NUMBER:
075600352
ADMINISTRATOR:KELLI GREENEFACILITY TYPE:
740
ADDRESS:1400 MONTEGOTELEPHONE:
(925) 938-6611
CITY:WALNUT CREEKSTATE: CAZIP CODE:
94598
CAPACITY:200CENSUS: 139DATE:
03/20/2024
UNANNOUNCEDTIME BEGAN:
02:30 PM
MET WITH:Resident Services Director Stephanie Ann ArabosTIME COMPLETED:
06:30 PM
ALLEGATION(S):
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Staff did not follow resident's care plan
Staff did not do a proper assessment of resident
INVESTIGATION FINDINGS:
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On 3/20/2024 at 2:30 PM, Licensing Program Analyst (LPA) J. Sampair arrived at facility unannounced to conduct an initial 10-day complaint investigation visit of the allegations above. Upon entry, the LPA informed Resident Services Director (RSD) Stephanie Ann Arabos of the purpose of the visit. The RSD informed Executive Director (ED) Kelli Greene and Regional Vice President (RVP) Aron Alexander by phone.

The complaint alleges that staff did not follow resident's care plan.
On 3/20/2024, the LPA reviewed the 2/14/2024 needs and services plan (care plan), 11/3/2022 to 3/20/2024 resident notes, 10/14/2023 physician's report, 2/14/2024 assessment, 3/20/2024 task list, and report of tasks completed for the months of February and March 2024. LPA interviewed Witnesses W1 and W2, RSD, ED, and RVP. The LPA's analysis of the data showed that the staff is following the resident's care plan.

Report Continued on LIC9099-C...
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Harpreet HumpalTELEPHONE: (510) 529-9416
LICENSING EVALUATOR NAME: James SampairTELEPHONE: (510) 286-4201
LICENSING EVALUATOR SIGNATURE:

DATE: 03/20/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/20/2024
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 2
Control Number 15-AS-20240314092013
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: 03/20/2024
NARRATIVE
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...Report Continued from LIC9099

The complaint alleges that staff did not do a proper assessment of resident.
On 3/20/2024, the LPA reviewed the 2/14/2024 needs and services plan (care plan), 11/3/2022 to 3/20/2024 resident notes, 10/14/2023 physician's report, 2/14/2024 assessment, 3/20/2024 task list, and report of tasks completed for the months of February and March 2024. LPA interviewed Witnesses W1 and W2, RSD, ED, and RVP. The LPA's analysis of the data showed that the staff did do a proper assessment of resident.

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

Exit interview conducted with RSD. Appeal Rights and a copy of this report provided via email.
SUPERVISOR'S NAME: Harpreet HumpalTELEPHONE: (510) 529-9416
LICENSING EVALUATOR NAME: James SampairTELEPHONE: (510) 286-4201
LICENSING EVALUATOR SIGNATURE:

DATE: 03/20/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/20/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 2