075601300-6-16-2025-15-AS-KHOS-DHQRY2-20250617132537

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 075601300
Report Date: 06/16/2025
Date Signed: 06/16/2025 03:03:47 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
03/07/2025 and conducted by Evaluator Tonica Syess-Gibson

PUBLIC

COMPLAINT CONTROL NUMBER: 15-AS-20250307133031

FACILITY NAME:	WESTMONT OF BRENTWOOD		FACILITY NUMBER:	075601300
ADMINISTRATOR:	AGUSTIN SAMANIEGO		FACILITY TYPE:	740
ADDRESS:	450 JOHN MUIR PKWY		TELEPHONE:	(925) 516-8006
CITY:	BRENTWOOD	STATE: CA	ZIP CODE:	94513
CAPACITY:	200	CENSUS: 100	DATE:	06/16/2025
		UNANNOUNCED	TIME BEGAN:	02:30 PM
MET WITH:	Scott Shahade, Executive Director		TIME COMPLETED:	03:20 PM

ALLEGATION(S):

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Facility staff do not ensure that resident's room is clean and sanitized.
Facility staff did not ensure that resident had clean linens.

INVESTIGATION FINDINGS:

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On 06/16/2025 at 2:30PM, Licensing Program Analyst (LPA) T. Syess-Gibson arrived unannounced to deliver findings for the above allegations. LPA met with Scott Shahade, Executive Director and explained the purpose of the visit.

During the course of the investigation, LPA T. Syess-Gibson and L. Hall interviewed staff, LPAs were unable to interview resident (R1) due to diagnosis. Admission agreement, housekeeping cleaning checklist, august health report (care report) for R1, R2, and R3 and staff scheduled (memory care)for the month of March 2025 were reviewed and obtained.

Continue on LIC9099C

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Harpreet Humpal	TELEPHONE: (510) 285-3928
LICENSING EVALUATOR NAME: Tonica Syess-Gibson	TELEPHONE: (510) 414-0641
LICENSING EVALUATOR SIGNATURE:	DATE: 06/16/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/16/2025

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-20250307133031

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: 06/16/2025

NARRATIVE

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Continued from LIC9099

Facility staff do not ensure that resident's room is clean and sanitized.

During the investigation LPAs interviewed staff and reviewed cleaning logs. During interviews with S1, S2 and S3 it was revealed that all residents’ rooms are scheduled to be cleaned weekly, if a resident needs cleaning in between their scheduled cleaning day, staff or memory care director will clean the residents’ room. During recorded review it was revealed which parts of the room was attended to during scheduled cleaning day.

Facility staff did not ensure that resident had clean linens.

During the investigation LPAs interviewed staff, and it was revealed that all residents have a schedule laundry day, if a resident has an accident in their bed and needs new linen it is changed immediately and washed. LPAs reviewed cleaning checklist with date and description of what was cleaned in residents’ rooms.

Based upon the information obtained during investigation. The above allegations are unsubstantiated. A finding that the complaint is UNSUBSTANTIATED means that although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violation occurred.

Exit interview conducted and a copy of report was given.

SUPERVISOR'S NAME: Harpreet Humpal	TELEPHONE: (510) 285-3928
LICENSING EVALUATOR NAME: Tonica Syess-Gibson	TELEPHONE: (510) 414-0641
LICENSING EVALUATOR SIGNATURE:	DATE: 06/16/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/16/2025

LIC9099 (FAS) - (06/04)

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