075601489-11-8-2023-15-AS-KHOS-D84RVP-20240813132152

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 075601489
Report Date: 11/08/2023
Date Signed: 11/08/2023 01:47:22 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
11/03/2023 and conducted by Evaluator James Sampair

PUBLIC

COMPLAINT CONTROL NUMBER: 15-AS-20231103160725

FACILITY NAME:	DIABLO ASSISTED LIVING I		FACILITY NUMBER:	075601489
ADMINISTRATOR:	BRAGG, JILL L.		FACILITY TYPE:	740
ADDRESS:	123 LOS CERROS AVENUE		TELEPHONE:	(925) 944-5363
CITY:	WALNUT CREEK	STATE: CA	ZIP CODE:	94598
CAPACITY:	6	CENSUS: 6	DATE:	11/08/2023
		UNANNOUNCED	TIME BEGAN:	09:00 AM
MET WITH:	Licensee/Administrator Jill Bragg		TIME COMPLETED:	02:00 PM

ALLEGATION(S):

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Staff did not timely notify the residents of renovations made to the facility
Staff did not follow a resident's medical need while in care

INVESTIGATION FINDINGS:

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On 11/08/23 at 9:00 AM, Licensing Program Analyst (LPA) J. Sampair performed an unannounced complaint visit pertaining to the above allegations. LPA met with staff persons S2 and S3 who were informed of the reason for the visit. Staff notified Licensee/Administrator Jill Bragg of the visit via telephone. She arrived at the facility at approximately 9:45 AM.

The complaint alleges that staff did not notify residents of renovations made to the facility in a timely manner. On 11/03/2023 at 1:49 PM, the LPA spoke with the Reporting Party (RP) who described the work that was done on the facility as painting and not a renovation of the facility. Family member W1 was interviewed in person. W1 stated that they had been notified in a timely manner, stating that “they keep me informed of what’s going on”, describing their family member’s care as “fantastic” and that they and other family members “praise this place to high heavens”.

CONTINUED ON LIC9099-C...

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Bennett Fong	TELEPHONE: (510) -62-2621
LICENSING EVALUATOR NAME: James Sampair	TELEPHONE: (510) 286-4201
LICENSING EVALUATOR SIGNATURE:	DATE: 11/08/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/08/2023

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-20231103160725

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: DIABLO ASSISTED LIVING I	FACILITY NUMBER: 075601489
	VISIT DATE: 11/08/2023

NARRATIVE

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...CONTINUED FROM LIC9099

The complaint alleges that staff did not follow a resident's medical needs while in care. On 11/08/2023, at 11:51 AM, the LPA interviewed residents R1, R2, R3, R4, and R5 as a group and asked if any of them had experienced any adverse medical reactions to the paint fumes during or after the painting at the facility. None of those residents reported that they had any adverse medical reactions to the paint. Resident R6 was not able to available to answer any questions. Staff person S2 at 12:10 PM and S4 at 12:13 PM were also asked if any residents or themselves had had any adverse reactions to the paint fumes. They also answered no, both adding that the kind of paint used had no odor, which was what S1 had reported when interviewed at approximately 10:00 AM.

Although the allegation may have happened, or is valid, there is not a preponderance of evidence to prove that staff did not notify residents of renovations made to the facility in a timely manner nor that staff did not follow a resident's medical needs while in care. Therefore, the allegations are UNSUBSTANTIATED.

Exit interview conducted with S2 and a copy of this report was provided.

SUPERVISOR'S NAME: Bennett Fong	TELEPHONE: (510) -62-2621
LICENSING EVALUATOR NAME: James Sampair	TELEPHONE: (510) 286-4201
LICENSING EVALUATOR SIGNATURE:	DATE: 11/08/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/08/2023

LIC9099 (FAS) - (06/04)

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