075600353-8-6-2024-15-AS-HHUL-D8SRUX-20240904132040

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 075600353
Report Date: 08/06/2024
Date Signed: 08/06/2024 05:54:03 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
01/05/2024 and conducted by Evaluator James Sampair

PUBLIC

COMPLAINT CONTROL NUMBER: 15-AS-20240105093717

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: 108	DATE:	08/06/2024
		UNANNOUNCED	TIME BEGAN:	03:00 PM
MET WITH:	Executive Director Monique Bindra		TIME COMPLETED:	06:00 PM

ALLEGATION(S):

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Staff did not prevent a resident from sustaining a fracture while in care.
Facility is not adequately staffed to meet the needs of the residents in care.
Staff are not serving nutritious meals to residents.

INVESTIGATION FINDINGS:

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On 8/6/2024 at 2:55 PM, Licensing Program Analyst (LPA) J. Sampair arrived unannounced to complete the investigation of the allegations above. The LPA informed Executive Director (ED) Monique Bindra of the reason for the visit.

The Department's investigation included, but was not limited to, interviews with staff, residents, and the Reporting Party (RP). The Department obtained and reviewed records pertaining to Resident R1, which included facility records, medical records, Emergency Medical Services (EMS) report, and 911 audio call recording. R1 was admitted to the facility on 3/31/2021.

Continued on LIC 9099-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: 08/06/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/06/2024

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-20240105093717

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 VALLEY VIEW	FACILITY NUMBER: 075600353
	VISIT DATE: 08/06/2024

NARRATIVE

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Continued from LIC 9099

The complaint alleges that staff did not prevent Resident R1 from sustaining a fracture while in care.
Review of the records and interviews of the ED and staff revealed that R1 was independent and only needed assistance using the restroom at night. R1 was not known to wander during the day or at night. When R1 fell outside on the patio and sustained a right leg fracture on 12/23/2023, it was the first time R1 tried to leave the facility at night.

The complaint alleges that Facility is not adequately staffed to meet the needs of the residents in care.
Review of the records and interviews of the ED and staff revealed that R1 was a fall risk and was placed on two-hour checks to make sure that she was in her room and safe. Interviews with overnight staff S1, S2, and S3 revealed that they responded to the door alarm in R1’s room within 5 minutes, in accordance with the facility’s policy.

The complaint alleges that staff are not serving nutritious meals to residents.
Review of the restaurant menu and interviews of 2 residents, R4 and R5, revealed that the facility staff are serving nutritious meals to the residents.

Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is UNSUBSTANTIATED.

Exit interview conducted 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: 08/06/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/06/2024

LIC9099 (FAS) - (06/04)

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