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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 075601035
Report Date: 11/08/2021
Date Signed: 11/08/2021 12:27:54 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
08/10/2020 and conducted by Evaluator Grace Luk
COMPLAINT CONTROL NUMBER: 15-AS-20200810100116
FACILITY NAME:CARRIAGE CAREFACILITY NUMBER:
075601035
ADMINISTRATOR:TUAZON, GABRIEL & ERLINDAFACILITY TYPE:
740
ADDRESS:1959 CARRIAGE DRIVETELEPHONE:
(925) 977-9678
CITY:WALNUT CREEKSTATE: CAZIP CODE:
94598
CAPACITY:6CENSUS: 4DATE:
11/08/2021
UNANNOUNCEDTIME BEGAN:
09:15 AM
MET WITH:Erlinda Tuazon, LicenseeTIME COMPLETED:
12:40 PM
ALLEGATION(S):
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Improper handling of resident resulted in resident receiving pain management treatment.

Staff do not provide proper care for resident.
INVESTIGATION FINDINGS:
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On 11/8/2021 at 9:15AM, Licensing Program Analyst (LPA) G. Luk arrived unannounced to deliver complaint findings for the allegations above. LPA met with Licensee, Erlinda Tuazon.

During the investigation, LPA interviewed staff, witnesses, and complainant. LPA obtained and reviewed R1's file including emergency information, physician's report, care plan, incident report, and hospice information.

Interview with witnesses revealed that R1 was receiving pain management treatment as a result of a bad back. Witnesses stated that R1 uses a hoyer lift to transfer to reduce pain during transfers.
(Continue LIC9099C...)
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Harpreet HumpalTELEPHONE: (510) 285-3928
LICENSING EVALUATOR NAME: Grace LukTELEPHONE: (510) 286-4201
LICENSING EVALUATOR SIGNATURE:

DATE: 11/08/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/08/2021
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-20200810100116
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: CARRIAGE CARE
FACILITY NUMBER: 075601035
VISIT DATE: 11/08/2021
NARRATIVE
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Interview with witnesses indicated that staff takes good care of R1. Witnesses stated that R1 would have a different change of clothes during in-person and virtual visits. Witnesses stated that R1 likes living at the facility and receiving better care. W1 stated that R1 sometimes refused hair cuts, but R1 is groomed regularly. Witnesses have described the facility as clean without odor and R1 is getting good care by staff. Witnesses can see that R1 is happier and able to sleep better at this facility.

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

No deficiencies are being cited on this date.

Exit interview conducted. A copy of this report provided.
SUPERVISOR'S NAME: Harpreet HumpalTELEPHONE: (510) 285-3928
LICENSING EVALUATOR NAME: Grace LukTELEPHONE: (510) 286-4201
LICENSING EVALUATOR SIGNATURE:

DATE: 11/08/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/08/2021
LIC9099 (FAS) - (06/04)
Page: 2 of 2