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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 079200294
Report Date: 01/08/2025
Date Signed: 01/08/2025 03:43:03 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
03/28/2024 and conducted by Evaluator Alona Gomez
COMPLAINT CONTROL NUMBER: 15-AS-20240328092708
FACILITY NAME:SUNRISE ASSISTED LIVING OF DANVILLEFACILITY NUMBER:
079200294
ADMINISTRATOR:KIRSTEN KORFHAGEFACILITY TYPE:
740
ADDRESS:1027 DIABLO RDTELEPHONE:
(925) 831-1740
CITY:DANVILLESTATE: CAZIP CODE:
94526
CAPACITY:89CENSUS: 66DATE:
01/08/2025
UNANNOUNCEDTIME BEGAN:
12:00 PM
MET WITH:Assisted Living Coordinator, Maria SalongaTIME COMPLETED:
04:00 PM
ALLEGATION(S):
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Staff are not meeting a resident's showering needs while in care
INVESTIGATION FINDINGS:
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On 1/8/2025 at 12:00 PM, Licensing Program Analyst (LPA) A. Gomez arrived unannounced to deliver findings for the above allegation. LPA met with Assisted Living Coordinator, Maria Salonga and explained the purpose of the visit.

During course of the investigation, LPA conducted interviews with facility staff, and R1. Documents including but not limited to: R1’s care plan(s), bath log from 10/23- 9/24, and internal point system records were obtained. LPA interviewed R1, Assisted Living Coordinator, and Resident Care Director.

Report continues on LIC9099-C
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Yvonne Flores-Larios
LICENSING EVALUATOR NAME: Alona Gomez
LICENSING EVALUATOR SIGNATURE:

DATE: 01/08/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/08/2025
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-20240328092708
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: SUNRISE ASSISTED LIVING OF DANVILLE
FACILITY NUMBER: 079200294
VISIT DATE: 01/08/2025
NARRATIVE
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LPA interviewed R1, who stated they are bathed every Monday and are satisfied with their bathing schedule. Additionally, the Resident Care Director was interviewed and explained that the only times R1 missed a bath were when they refused or were unavailable due to hospitalization. The Assisted Living Coordinator corroborated this, noting that R1's bath schedule was changed in December 2023, from 5 times a week to once a week.

LPA reviewed two care plans. The care plan dated 10/09/2023 indicated that R1 preferred to be bathed daily. However, the care plan dated 10/19/2024 reflected that R1 preferred to shower once a week on Monday evenings. LPA was also provided with a "PointClickCare" document showing that, as of 12/04/2023, R1's bath schedule was reduced to once a week.

Further review of the bath log revealed a total of 90 documented baths for R1 between October 2023 and September 2024. During this period, R1 refused baths 7 times and was unavailable on 3 occasions.

Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is UNSUBSTANTIATED.
SUPERVISORS NAME: Yvonne Flores-Larios
LICENSING EVALUATOR NAME: Alona Gomez
LICENSING EVALUATOR SIGNATURE:

DATE: 01/08/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/08/2025
LIC9099 (FAS) - (06/04)
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