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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 075601300
Report Date: 08/29/2023
Date Signed: 08/29/2023 02:36:29 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
08/25/2023 and conducted by Evaluator James Sampair
PUBLIC
COMPLAINT CONTROL NUMBER: 15-AS-20230825100325
FACILITY NAME:WESTMONT OF BRENTWOODFACILITY NUMBER:
075601300
ADMINISTRATOR:AGUSTIN SAMANIEGOFACILITY TYPE:
740
ADDRESS:450 JOHN MUIR PKWYTELEPHONE:
(925) 516-8006
CITY:BRENTWOODSTATE: CAZIP CODE:
94513
CAPACITY:200CENSUS: 97DATE:
08/29/2023
UNANNOUNCEDTIME BEGAN:
09:15 AM
MET WITH:Executive Director Michael TalaniTIME COMPLETED:
03:15 PM
ALLEGATION(S):
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Facility staff not assisting resident with catheter needs.
INVESTIGATION FINDINGS:
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On 08/29/2023 at 9:15 AM, Licensing Program Analyst (LPA) J. Sampair arrived unannounced to conduct this complaint investigation. LPA explained the purpose of the visit to Executive Director (ED) Michael Talani.

During the investigation, the LPA interviewed the Reporting Party (RP), the ED, and Witness W1. The LPA also reviewed Resident R1's records. Listed below is the allegation and a brief explanation of the evidence upon which the finding was based:

(Continued on LIC9099-C...)
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Bennett FongTELEPHONE: (510) -62-2621
LICENSING EVALUATOR NAME: James SampairTELEPHONE: (510) 286-4201
LICENSING EVALUATOR SIGNATURE:

DATE: 08/29/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/29/2023
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-20230825100325
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: WESTMONT OF BRENTWOOD
FACILITY NUMBER: 075601300
VISIT DATE: 08/29/2023
NARRATIVE
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(...Continued from LIC9099)

Facility staff not assisting resident with catheter needs.
Based on a review of Resident R1's records, and interviews of the RP, the ED, and Witness W1, no evidence was found that staff members were not assisting Resident R1 with his indwelling catheter needs in accordance with Section 87623 of the Title 22 regulations.

Title 22 Section 87623 states that: "(a) The licensee shall be permitted to accept or retain a resident who requires the use of an indwelling catheter . . . (1) If the resident is physically and mentally capable of caring for all aspects of the condition except insertion and irrigation." and "(b) . . . the licensee shall be responsible for the following: (2) Ensuring that the bag and tubing are changed by an appropriately skilled professional should the resident require assistance." It does not require that the facility provide that level of care to all residents.

Although the allegations may have happened, or are 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 was conducted with ED. A copy of this report was provided via email.
SUPERVISOR'S NAME: Bennett FongTELEPHONE: (510) -62-2621
LICENSING EVALUATOR NAME: James SampairTELEPHONE: (510) 286-4201
LICENSING EVALUATOR SIGNATURE:

DATE: 08/29/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/29/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 2