075600352-11-22-2021-15-AS-KHOS-C9BR6Z-20211202114534

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 075600352
Report Date: 11/22/2021
Date Signed: 11/22/2021 12:49:30 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
11/02/2021 and conducted by Evaluator Daisy Panlilio

COMPLAINT CONTROL NUMBER: 15-AS-20211102151915

FACILITY NAME:	ATRIA WALNUT CREEK		FACILITY NUMBER:	075600352
ADMINISTRATOR:	COONS, JENNIFER		FACILITY TYPE:	740
ADDRESS:	1400 MONTEGO		TELEPHONE:	(925) 938-6611
CITY:	WALNUT CREEK	STATE: CA	ZIP CODE:	94598
CAPACITY:	200	CENSUS: 115	DATE:	11/22/2021
		UNANNOUNCED	TIME BEGAN:	11:40 AM
MET WITH:	Barbara Tudda, Executive Director		TIME COMPLETED:	01:00 PM

ALLEGATION(S):

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Staff did not safeguard resident's personal property

INVESTIGATION FINDINGS:

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On 11/22/21 at 11:40AM, Licensing Program Analyst (LPA) Daisy Panlilio conducted a subsequent complaint visit and delivered the finding to Executive Director (ED). LPA explained the purpose of the visit with ED.

Allegation: Staff did not safeguard resident’s personal property
Investigation Finding: Unfounded
Review of R1’s physician’s report dated 11/20/20 show R1 had auditory impairment with no assistive device noted/declared. Thus, facility has no record of R1 having the auditory device. LPA also reviewed R1’s safeguard of property and valuables report (LIC 621) dated 05/18/2015 which did not list or declare any assistive auditory device. Staff confirmed with LPA that R1 or her authorized representative did not report any hearing aide theft or loss to management during her stay at the facility.
Continued on next page, LIC 9099-C

Unfounded

Estimated Days of Completion:

SUPERVISOR'S NAME: Bennett Fong	TELEPHONE: (510) 622-2621
LICENSING EVALUATOR NAME: Daisy Panlilio	TELEPHONE: (510) 286-4201
LICENSING EVALUATOR SIGNATURE:	DATE: 11/22/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/22/2021

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

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Control Number 15-AS-20211102151915

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: ATRIA WALNUT CREEK	FACILITY NUMBER: 075600352
	VISIT DATE: 11/22/2021

NARRATIVE

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LPA also reviewed resident’s (R1) hearing aide invoices dated 10/16/2014 until 10/15/2020 which showed the type of hearing aides that R1 wore were invisible, had no battery nor self-removal required and were changed out annually via subscription by R1’s hearing center which explains the annual charges incurred by R1 every October even prior to first admittance at the facility. Date of R1's facility admission was 05/18/2015 per admission agreement.

This department had investigated the complaint alleging that staff did not safeguard R1’s personal property. We have found that the complaint was unfounded, meaning that the allegation was false, could not have happened and/or is without reasonable basis. We have therefore dismissed the complaint.

No deficiencies cited. Exit Interview conducted and a copy of this report provided via email.

SUPERVISOR'S NAME: Bennett Fong	TELEPHONE: (510) 622-2621
LICENSING EVALUATOR NAME: Daisy Panlilio	TELEPHONE: (510) 286-4201
LICENSING EVALUATOR SIGNATURE:	DATE: 11/22/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/22/2021

LIC9099 (FAS) - (06/04)

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