075600353-5-12-2023-15-AS-KHOS-D4MHRM-20240424062546

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 075600353
Report Date: 05/12/2023
Date Signed: 05/12/2023 05:45:46 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
05/08/2023 and conducted by Evaluator James Sampair

PUBLIC

COMPLAINT CONTROL NUMBER: 15-AS-20230508150522

FACILITY NAME:	ATRIA VALLEY VIEW		FACILITY NUMBER:	075600353
ADMINISTRATOR:	KELLI L GREENE		FACILITY TYPE:	740
ADDRESS:	1228 ROSSMOOR PKWY		TELEPHONE:	(925) 937-7300
CITY:	WALNUT CREEK	STATE: CA	ZIP CODE:	94595
CAPACITY:	153	CENSUS: 101	DATE:	05/12/2023
		UNANNOUNCED	TIME BEGAN:	01:15 PM
MET WITH:	Interim Executive Director (IED) Kawana Anthony		TIME COMPLETED:	06:00 PM

ALLEGATION(S):

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Staff did not assist resident with showering as needed.
Staff did not assist resident with dressing as needed.
Staff did not provide appropriate food service for diabetic resident.
Staff did not disinfect visibly soiled surfaces.
Resident's air conditioning is in disrepair.
Staff did not safeguard resident's valuables.

INVESTIGATION FINDINGS:

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On 05/12/2023 at 1:15 PM, Licensing Program Analyst (LPA) J. Sampair arrived unannounced to conduct an initial 10-day investigation regarding the above allegations. LPA explained the purpose of the visit to front desk staff and later with Interim Executive Director (IED) Kawana Anthony.

LPA interviewed the Administrator, 3 residents, and conducted a review of resident and facility records.

Staff did not assist resident with showering as needed.
No evidence that Resident R1 was being provided additional assistance with showering at that time, so therefore, there was no evidence that those services had not been provided.

Staff did not assist resident with dressing as needed.
No evidence that Resident R1 was being provided additional assistance with dressing at that time, so therefore, there was no evidence that those services had not been provided.

(Continued on LIC9099-C...)

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: 05/12/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/12/2023

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-20230508150522

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 VALLEY VIEW	FACILITY NUMBER: 075600353
	VISIT DATE: 05/12/2023

NARRATIVE

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(...Continued from LIC9099)

Staff did not provide appropriate food service for diabetic resident.
Admissions agreement for residents does not include food service for diabetic residents. Instead, it is something residents must provide for themselves if/when the need arises.

Staff did not disinfect visibly soiled surfaces.
No evidence that Staff were not disinfecting visibly soiled surfaces.

Resident's air conditioning is in disrepair.
Resident's air conditioner was working and the room temperature was measured at 77 degrees F, which is within the safe range.

Staff did not safeguard resident's valuables.
No evidence that Residents' valuables were not being safeguarded.

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

Exit interview conducted and a copy of this report provided via email.

SUPERVISOR'S NAME: Harpreet Humpal	TELEPHONE: (510) 285-3928
LICENSING EVALUATOR NAME: James Sampair	TELEPHONE: (510) 286-4201
LICENSING EVALUATOR SIGNATURE:	DATE: 05/12/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/12/2023

LIC9099 (FAS) - (06/04)

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