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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 075601300
Report Date: 03/18/2025
Date Signed: 03/18/2025 05:41:02 PM

Substantiated


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
03/26/2024 and conducted by Evaluator Grace Luk
PUBLIC
COMPLAINT CONTROL NUMBER: 15-AS-20240326163152
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: 101DATE:
03/18/2025
UNANNOUNCEDTIME BEGAN:
10:15 AM
MET WITH:Scott Shahade, Executive Director
Mercedes Villarreal, Resident Service Director		TIME COMPLETED:
05:45 PM
ALLEGATION(S):
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Staff did not provide assistance to a resident in a timely manner.
Insufficient staffing
INVESTIGATION FINDINGS:
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On 3/18/2025 at 10:15AM, Licensing Program Analyst (LPA) G. Luk arrived unannounced to conduct a complaint investigation and deliver findings in regards to the allegations above. LPA met with Executive Director (ED), Scott Shahade and informed him reason for the visit. ED was unable to sign the report and authorized Resident Service Director, Mercedes Villarreal to sign the reports.

During the course of investigation, LPA interviewed 6 residents, 7 staff, witness, and complainant. LPA reviewed and obtained documents (staff roster with contact information, staff schedule, call button records, physician's report, emergency information, care notes, and care plan).

Staff did not provide assistance to a resident in a timely manner.
After reviewing R1's call button records, it was identified there were multiple incidents where R1 waited over 30 minutes for staff to respond to the call in March of 2024. Interview with witness revealed that R1 waited over 30 minutes for assistance. Interview with R2 indicated that night shift response time can take 30-60 minutes.
(Continue on LIC9099C...)
Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Harpreet HumpalTELEPHONE: (510) 285-3928
LICENSING EVALUATOR NAME: Grace LukTELEPHONE: (510) 286-4201
LICENSING EVALUATOR SIGNATURE:

DATE: 03/18/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/18/2025
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 3
Control Number 15-AS-20240326163152
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: WESTMONT OF BRENTWOOD
FACILITY NUMBER: 075601300
VISIT DATE: 03/18/2025
NARRATIVE
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Insufficient staffing
Interview with staff indicated that R1 needed 2-person assist and R1 would need to wait a long time for the second staff during showers, transfers, toileting, and other ADL (Activities of Daily Living) needs. Staff stated there was an incident where R1 and S8 waited over 40 minutes for the second staff to respond to call button for assisting R1's ADL care.

Based on LPA's information obtained during investigation, the preponderance of evidence standard has been met; therefore, the above allegations are found to be SUBSTANTIATED. California Code of Regulations, Title 22, are being cited on the attached LIC 9099D.

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

DATE: 03/18/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/18/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 15-AS-20240326163152
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: WESTMONT OF BRENTWOOD
FACILITY NUMBER: 075601300
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/18/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
04/07/2025
Section Cited
CCR
87468.2(a)(4)
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Additional Personal Rights of Residents in Privately Operated Facilities. To care, supervision, and services that meet their individual needs and are delivered by staff that are sufficient in numbers... This requirement is not met as evidence by:
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Facility has agreed to create a plan to address staffing needs/call button response and will provide a copy of the plan to CCLD by POC date.
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Based on investigation, licensee did not comply with the section cited above by not responding to call button in a timely manner which poses a potential health and safety risk to the persons in care.
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Type B
04/07/2025
Section Cited
CCR
87411(a)
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Personnel Requirements - General. Facility personnel shall at all times be sufficient in numbers...to meet resident needs... This requirement is not met as evidence by:
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Facility has agreed to create a plan to address staffing needs/call button response and will provide a copy of the plan to CCLD by POC date.
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Based on investigation, licensee did not comply with the section cited above by not having sufficient staffing which poses a potential health and safety risk to the persons 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: Harpreet HumpalTELEPHONE: (510) 285-3928
LICENSING EVALUATOR NAME: Grace LukTELEPHONE: (510) 286-4201
LICENSING EVALUATOR SIGNATURE:

DATE: 03/18/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/18/2025
LIC9099 (FAS) - (06/04)
Page: 3 of 3