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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 075600578
Report Date: 12/12/2024
Date Signed: 12/12/2024 10:46:00 AM

Substantiated


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
12/05/2024 and conducted by Evaluator Alona Gomez
COMPLAINT CONTROL NUMBER: 15-AS-20241205132733
FACILITY NAME:CONCORD ROYALEFACILITY NUMBER:
075600578
ADMINISTRATOR:KUHLMANN, MARIA CONNIEFACILITY TYPE:
740
ADDRESS:4230 CLAYTON ROADTELEPHONE:
(925) 676-3410
CITY:CONCORDSTATE: CAZIP CODE:
94521
CAPACITY:160CENSUS: 88DATE:
12/12/2024
UNANNOUNCEDTIME BEGAN:
09:50 AM
MET WITH:Executive Director, Maria "Connie" KuhlmannTIME COMPLETED:
11:00 AM
ALLEGATION(S):
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Facility staff did not maintain passageway(s) free from obstruction
INVESTIGATION FINDINGS:
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On 12/12/2024 at 9:50 AM, Licensing Program Analyst (LPA) A. Gomez arrived unannounced to conduct the initial visit and deliver findings for the above allegation. LPA met with Executive Director (ED) and explained the purpose of the visit.

LPA informed ED of the allegation and ED immediatly stated that "Yes there were exits blocked". ED stated that they were blocked for gardening and are now clear. LPA toured facility and observed that all exits are now clear.

Based on LPAs interview conducted, the preponderance of evidence standard has been met, therefore the above allegations are found to be SUBSTANTIATED. California Code of Regulations (Title 22, Division 6, Chapter 8), are being cited on the attached LIC 9099D.
Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Yvonne Flores-LariosTELEPHONE: (510) -28-0517
LICENSING EVALUATOR NAME: Alona GomezTELEPHONE: 510-239-1306
LICENSING EVALUATOR SIGNATURE:

DATE: 12/12/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/12/2024
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-20241205132733
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: CONCORD ROYALE
FACILITY NUMBER: 075600578
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/12/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
12/12/2024
Section Cited
CCR
87203
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All facilities shall be maintained... with the regulations adopted by the State Fire Marshal for the protection of life ... and panic.
This requirement is not met as evidenced by
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Executive Director has removed the obstructions and agrees to no longer block doors with objects. POC cleared.
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Based on interview Facility did not comply with the regulation above by having exits blocked with benches to prevent residents going outside during landscaping which posed an immediate safety risk to residents in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME: Yvonne Flores-LariosTELEPHONE: (510) -28-0517
LICENSING EVALUATOR NAME: Alona GomezTELEPHONE: 510-239-1306
LICENSING EVALUATOR SIGNATURE:

DATE: 12/12/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/12/2024
LIC9099 (FAS) - (06/04)
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