079200290-1-31-2023-15-AS-HHUL-CQCSLR-20230328135845

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 079200290
Report Date: 01/31/2023
Date Signed: 01/31/2023 04:37:59 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
01/26/2023 and conducted by Evaluator James Sampair

PUBLIC

COMPLAINT CONTROL NUMBER: 15-AS-20230126140801

FACILITY NAME:	A PLACE FOR SENIORS, LLC		FACILITY NUMBER:	079200290
ADMINISTRATOR:	DISTEFANO, KAMILLA		FACILITY TYPE:	740
ADDRESS:	257 NORMANDY LANE		TELEPHONE:	(925) 516-6665
CITY:	WALNUT CREEK	STATE: CA	ZIP CODE:	94598
CAPACITY:	6	CENSUS: 6	DATE:	01/31/2023
		UNANNOUNCED	TIME BEGAN:	01:00 PM
MET WITH:	Kamilla Distefano		TIME COMPLETED:	03:00 PM

ALLEGATION(S):

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1. Facility staff are not adequately trained.
2. Facility staff leave residents in soiled diapers for extended periods of time.
3. Facility staff are not ensuring that residents receive showers.
4. Facility staff are misusing resident's account to purchase items not for the resident.

INVESTIGATION FINDINGS:

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On 01/31/2023 at 1:00PM, Licensing Program Analyst (LPA) J. Sampair arrived unannounced to conduct complaint investigation. LPA met with Administrator (ADM) Kamilla Distefano.

LPA inspected the facility, reviewed documentation, and conducted interviews of 1 resident and 4 staff members.

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

No citations were issued.

Exit interview conducted. A copy of this report provided via email.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Harpreet Humpal	TELEPHONE: (510) 285-3928
LICENSING EVALUATOR NAME: James Sampair	TELEPHONE: (510) 286-4201
LICENSING EVALUATOR SIGNATURE:	DATE: 01/31/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/31/2023

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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