075601363-11-13-2025-15-AS-BFOG-DNHSW5-20251117131346

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 075601363
Report Date: 11/13/2025
Date Signed: 11/13/2025 05:03:06 PM

Unsubstantiated

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
01/08/2025 and conducted by Evaluator Lori Alexander-Washington

PUBLIC

COMPLAINT CONTROL NUMBER: 15-AS-20250108111242

FACILITY NAME:	MEMORY CARE OF CONTRA COSTA		FACILITY NUMBER:	075601363
ADMINISTRATOR:	DIALA, ERICA		FACILITY TYPE:	740
ADDRESS:	540 PATTERSON BOULEVARD		TELEPHONE:	(925) 287-8750
CITY:	PLEASANT HILL	STATE: CA	ZIP CODE:	94523
CAPACITY:	75	CENSUS: 56	DATE:	11/13/2025
		UNANNOUNCED	TIME BEGAN:	03:35 PM
MET WITH:	Tracey Ingleman, Executive Director		TIME COMPLETED:	05:15 PM

ALLEGATION(S):

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Staff retained resident requiring a higher level of care.
Staff did not adequately manage resident’s behaviors.
Staff did not safeguard resident’s personal belongings.

INVESTIGATION FINDINGS:

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On 11/13/2025 at 3:35 PM, Licensing Program Analyst (LPA) L. Alexander conducted a subsequent visit and met with Executive Director, Tracey Ingleman, to deliver the findings of above allegations. LPA explained the purpose of the visit with Jonathan Centeno, Director of Resident Services. Tracey Ingleman arrived shortly after.

During the investigation, the Department obtained the following documents from the facility: Resident Roster, Staff Roster, Dementia Training Calendar 2024, R1’s Admission Agreement, Physician’s Reports (dated 08/14/24 and 11/06/24), Pre-Admission Appraisal (dated 10/22/24), Medication List, R1’s Face Sheet, Doctor’s Orders, Hospice Care Plan (if applicable for Residents R1–R5), Internal Incident Report (dated 10/28/24), and SOC 341 (dated 11/10/24).

LIC9099-C Continued....

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Bennett Fong
LICENSING EVALUATOR NAME: Lori Alexander-Washington
LICENSING EVALUATOR SIGNATURE:	DATE: 11/13/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/13/2025

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-20250108111242

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: 11/13/2025

NARRATIVE

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LIC9099-C (Page 2)

Allegation: Staff retained resident requiring a higher level of care
Finding: Unsubstantiated

On 01/13/2025, Licensing Program Analyst (LPA) interviewed Witness 1 (W1), who stated that they began receiving multiple bills from ambulance services and hospital visits that they were unable to pay. W1 reported that they were not the one contacting 911 or sending Resident 1 (R1) to the emergency room (ER). W1 stated that R1 was sent to John Muir Hospital in Concord because R1 “wasn’t listening.” W1 further stated that R1 had been diagnosed with frontal lobe dementia, which required a higher level of care than what the facility could provide. W1 further stated that when R1 went to John Muir Walnut Creek he was sent back to the facility on hospice because they think the "idea to not send him back and that John Muir doesn't want to keep seeing him constantly." W1 stated that R1 was only on two types of meds and once he got on hospice, seven more types of medications were added.

LPA reviewed R1’s Physician’s Reports (dated 08/14/2024 and 11/06/2024), which indicate a diagnosis of possible frontotemporal dementia, with additional notes reflecting behavioral disturbance and advanced dementia, respectively. Record review showed a change in R1’s condition, with documentation of increased confusion, disorientation, refusal or forgetfulness in following instructions, and episodes of aggressive behavior. The Pre-Admission Appraisal (dated 10/22/2024) notes “Higher level of care” for Question #1. Despite these findings, the overall Care Plan identifies R1 as mostly independent in activities of daily living. LPA reviewed that 911 was called 10/28/24 and 11/10/24 per internal incident reports.

LIC9099-C Continued...

SUPERVISORS NAME: Bennett Fong
LICENSING EVALUATOR NAME: Lori Alexander-Washington
LICENSING EVALUATOR SIGNATURE:	DATE: 11/13/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/13/2025

LIC9099 (FAS) - (06/04)

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Control Number 15-AS-20250108111242

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: 11/13/2025

NARRATIVE

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LIC9099-C (Page 3)

Allegation: Staff did not adequately manage resident’s behaviors

Finding: Unsubstantiated

On 01/13/2025, LPA interviewed W1, who reported that R1 exhibited aggressive and inappropriate verbal behaviors, including racial slurs and profanity directed at W1, their pet, and neighbors. W1 stated that R1’s behaviors were difficult to manage and that facility staff—many of whom were students—should have been better trained to address dementia related behavioral issues. W1 stated that despite these ongoing behavioral challenges, the facility repeatedly sent R1 to the emergency room instead of implementing effective behavior management interventions or arranging a more appropriate level of care.

LPA reviewed the staff “2024 Annual Veteran Training Calendar.” (updated October 31, 2024). The training calendar shows courses on Resident Rights and Elder Abuse (in relation to Dementia), Dementia: Positive Approach and Dementia: Leading Causes of Expressions and How to Respond as examples.

Allegation: Staff did not safeguard resident’s personal belongings

Finding: Unsubstantiated

During interviews, W1 stated that R1’s missing blanket was later located. There was insufficient evidence to determine that the facility failed to safeguard R1’s personal belongings.

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

No deficiencies were cited during today’s visit.

An exit interview was conducted with Executive Director, Tracey Ingleman and a copy of this report was provided.

SUPERVISORS NAME: Bennett Fong
LICENSING EVALUATOR NAME: Lori Alexander-Washington
LICENSING EVALUATOR SIGNATURE:	DATE: 11/13/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/13/2025

LIC9099 (FAS) - (06/04)

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