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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 075601363
Report Date: 11/10/2025
Date Signed: 11/10/2025 02:50:03 PM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
E BAY DELTA AC/SC, 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
11/20/2024 and conducted by Evaluator Lori Alexander-Washington
PUBLIC
COMPLAINT CONTROL NUMBER: 15-AS-20241120095158
FACILITY NAME:MEMORY CARE OF CONTRA COSTAFACILITY NUMBER:
075601363
ADMINISTRATOR:DIALA, ERICAFACILITY TYPE:
740
ADDRESS:540 PATTERSON BOULEVARDTELEPHONE:
(925) 287-8750
CITY:PLEASANT HILLSTATE: CAZIP CODE:
94523
CAPACITY:75CENSUS: 57DATE:
11/10/2025
UNANNOUNCEDTIME BEGAN:
01:50 PM
MET WITH:Jonathan Centeno, Director of Resident ServicesTIME COMPLETED:
03:00 PM
ALLEGATION(S):
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Staff member handled resident in care in a rough manner.
Licensee does not ensure that required information is in areas of the facility accessible to residents,
INVESTIGATION FINDINGS:
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On 11/10/2025 at 1:50 PM, Licensing Program Analyst (LPA) L. Alexander conducted a subsequent visit and met with Director of Resident Services (DRS), Jonathan Centeno, to deliver the findings of above allegations. LPA explained the purpose of the visit with DRS.

During the course of the investigation, the Department obtained the following documents from the facility: Resident Face Sheet, Physician’s Report, Admission Agreement, Pre-Admission Evaluation, Pharmaceutical Services, Carlton Incident Reports, and a Staff Written Statement.


LIC9099-C
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Bennett Fong
LICENSING EVALUATOR NAME: Lori Alexander-Washington
LICENSING EVALUATOR SIGNATURE:

DATE: 11/10/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/10/2025
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 4
Control Number 15-AS-20241120095158
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
E BAY DELTA AC/SC, 1515 CLAY STREET, STE. 310
OAKLAND, CA 94612
FACILITY NAME: MEMORY CARE OF CONTRA COSTA
FACILITY NUMBER: 075601363
VISIT DATE: 11/10/2025
NARRATIVE
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LIC9099-C (Page 2)

Allegation: Staff member handled resident in care in a rough manner.
Finding: Substantiated

Investigation revealed that Witness 1 (W1) stated Resident 1 (R1) has possible frontal lobe dementia with behavioral challenges. On 11/10/2024, R1 became agitated and began yelling racial slurs toward Staff 1 (S1) and threatening to kill staff. W1 reported that R1 would not calm down, and S1 placed their hand over R1’s mouth in an attempt to stop R1 from yelling.

On 11/21/2024 LPA interviewed S2 that stated R1 was yelling racial slurs at S1. S1 attempted to try to calm the matter and S1 covered R1’s mouth and then later called the police. S1 stated that R1 was placed on leave and later terminated after their internal investigation.

Allegation: Licensee does not ensure that required information is in areas of the facility accessible to residents, representatives, and the public.
Finding: Substantiated

Investigation revealed that W1 stated the ombudsman contact poster was missing from the facility. LPA’s observation confirmed that the ombudsman contact information poster was not posted in an area accessible to residents, representatives, and the public. S1 stated that R1 had torn the poster down from the wall.
SUPERVISORS NAME: Bennett Fong
LICENSING EVALUATOR NAME: Lori Alexander-Washington
LICENSING EVALUATOR SIGNATURE:

DATE: 11/10/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/10/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 4
Control Number 15-AS-20241120095158
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
E BAY DELTA AC/SC, 1515 CLAY STREET, STE. 310
OAKLAND, CA 94612

FACILITY NAME: MEMORY CARE OF CONTRA COSTA
FACILITY NUMBER: 075601363
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/10/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
11/17/2025
Section Cited
CCR
87468.2(a)(8)
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87468.2 Additional Personal Rights of Residents in Privately Operated Facilities (a) In addition to the rights listed in Section 87468.1, Personal Rights of Residents in All Facilities, residents in privately operated residential care facilities for the elderly shall have all of the following personal rights:
(8) To be free from neglect, financial exploitation, involuntary seclusion, punishment, humiliation, intimidation, and verbal, mental, physical, or sexual abuse.

This requirement is not met as evidenced by:
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Licensee shall ensure all staff receive training regarding residents’ personal rights, including techniques for de-escalation and appropriate interventions for residents exhibiting behavioral challenges. Proof of training shall be submitted to the Department by POC due date.
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Based on interviews, the licensee did not comply with the section cited above when S1 placed their hand over R1’s mouth while R1 was agitated. This conduct violates the resident’s personal rights and poses an immediate health and safety risk to residents in care.
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Type B
11/17/2025
Section Cited
CCR
87211(a)(1)(A)
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CCR 87211(a)(1)(A) – Reporting Requirements

Each licensee shall ensure that required information, including contact information for the Licensing Agency, Ombudsman, and other public resources, is posted in areas accessible to residents, representatives, and the public.

This requirement is not met as evidenced by:
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Licensee shall immediately replace the missing ombudsman contact poster in an area accessible to residents and visitors. Licensee shall submit photographic proof of posting to the Department by POC due date.
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During the visit, the licensee did not comply with the section cited above when LPA observed that the ombudsman contact poster was missing from the facility’s common area This poses a potential health, safety or personal rights risk to persons in care.
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LPA observed Ombudsman poster was posted in the hall entrance.

Deficiency cleared during visit.
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISORS NAME: Bennett Fong
LICENSING EVALUATOR NAME: Lori Alexander-Washington
LICENSING EVALUATOR SIGNATURE:

DATE: 11/10/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/10/2025
LIC9099 (FAS) - (06/04)
Page: 3 of 4
Control Number 15-AS-20241120095158
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
E BAY DELTA AC/SC, 1515 CLAY STREET, STE. 310
OAKLAND, CA 94612
FACILITY NAME: MEMORY CARE OF CONTRA COSTA
FACILITY NUMBER: 075601363
VISIT DATE: 11/10/2025
NARRATIVE
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LIC9099-C (Page 3)

Based on LPAs observations and interviews which were conducted and record reviews, 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.

Exit interview conducted. Appeal Rights and a copy of this report provided.
SUPERVISORS NAME: Bennett Fong
LICENSING EVALUATOR NAME: Lori Alexander-Washington
LICENSING EVALUATOR SIGNATURE:

DATE: 11/10/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/10/2025
LIC9099 (FAS) - (06/04)
Page: 4 of 4