075601424-4-4-2022-15-AS-KHOS-CDLJWS-20220418072514

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 075601424
Report Date: 04/04/2022
Date Signed: 04/04/2022 06:25:34 PM

Unsubstantiated

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
01/03/2022 and conducted by Evaluator Catherine Lin

PUBLIC

COMPLAINT CONTROL NUMBER: 15-AS-20220103103346

FACILITY NAME:	AEGIS ASSISTED LIVING OF MORAGA		FACILITY NUMBER:	075601424
ADMINISTRATOR:	RICHARD PIELSTICK		FACILITY TYPE:	740
ADDRESS:	950 COUNTRY CLUB DRIVE		TELEPHONE:	(925) 377-7900
CITY:	MORAGA	STATE: CA	ZIP CODE:	94556
CAPACITY:	100	CENSUS: 65	DATE:	04/04/2022
		UNANNOUNCED	TIME BEGAN:	09:25 AM
MET WITH:	Won Suk Choi, Business Office Manager		TIME COMPLETED:	06:40 PM

ALLEGATION(S):

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COVID-19 protocols are not being followed.
Staff are made to work while positive with COVID-19.

INVESTIGATION FINDINGS:

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On 4/4/22 at 9:25am, Licensing Program Analyst (LPA) Catherine Lin conducted an unannounced subsequent complaint investigation regarding the above allegations and deliver investigation findings. LPA explained the purpose of the visit with the Business Office Manager, Won Suk Choi.

Allegation: COVID-19 protocols are not being followed– Unsubstantiated
The Department has investigated this allegation and per interviews and records review, facility followed Covid-19 protocols by Contra Costa Public Health and Community Care Licensing. Staff was informed to stay home when they were feeling sick and quarantined at home when they were tested Covid-19 positive. During Covid-19 surge and staff shortage, Administrator utilized staffing agency (Senior Care Plus Agency), and also was instructed by Contra Costa Public Health (W1) that Covid-19 positive staff with asymptomatic were allowed to return to work as needed.

Continue on LIC9099C

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Bennett Fong	TELEPHONE: (510) -62-2621
LICENSING EVALUATOR NAME: Catherine Lin	TELEPHONE: 510-622-2053
LICENSING EVALUATOR SIGNATURE:	DATE: 04/04/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/04/2022

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-20220103103346

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: AEGIS ASSISTED LIVING OF MORAGA	FACILITY NUMBER: 075601424
	VISIT DATE: 04/04/2022

NARRATIVE

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Allegation: Staff are made to work while positive with COVID-19– Unsubstantiated

The Department has investigated this allegation and per interviews and records review, facility followed Covid-19 protocols by Contra Costa Public Health and Community Care Licensing. None of the staff stated that they were made to work when they were sick or tested Covid-19 positive. S8 with mild symptoms continued to work because 2 times of home tests showed negative result, however, the PCR positive result came back after 5 days where S8’s symptoms were completed gone, S8 was allowed to returned to work. S3, S9 and S11 were sent home when they were noticed being sick or received Covid-19 positive result.

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

No deficiencies cited. Exit interview conducted Business Office Manager and a copy of this report provided.

SUPERVISOR'S NAME: Bennett Fong	TELEPHONE: (510) -62-2621
LICENSING EVALUATOR NAME: Catherine Lin	TELEPHONE: 510-622-2053
LICENSING EVALUATOR SIGNATURE:	DATE: 04/04/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/04/2022

LIC9099 (FAS) - (06/04)

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