079200294-8-8-2025-15-AS-YFLS-DKVNAF-20250825101727

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 079200294
Report Date: 08/08/2025
Date Signed: 08/08/2025 02:33:37 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
01/30/2025 and conducted by Evaluator Alona Gomez

COMPLAINT CONTROL NUMBER: 15-AS-20250130154001

FACILITY NAME:	SUNRISE ASSISTED LIVING OF DANVILLE		FACILITY NUMBER:	079200294
ADMINISTRATOR:	KIRSTEN KORFHAGE		FACILITY TYPE:	740
ADDRESS:	1027 DIABLO RD		TELEPHONE:	(925) 831-1740
CITY:	DANVILLE	STATE: CA	ZIP CODE:	94526
CAPACITY:	89	CENSUS: 74	DATE:	08/08/2025
		UNANNOUNCED	TIME BEGAN:	01:00 PM
MET WITH:	Memory Care Director, Leslie Guerrero		TIME COMPLETED:	03:00 PM

ALLEGATION(S):

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Staff did not provide proper care to resident
Staff did not provide detailed monthly billing invoices of costs and charges to resident's responsible party
Staff did not give refund to resident's responsible party

INVESTIGATION FINDINGS:

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On 8/8/2025 at 1:00PM, Licensing Program Analyst (LPA) A Gomez arrived unannounced to deliver findings in regard to the allegations above. LPA met with Memory Care Director, Leslie Guerrero and explained the purpose of the visit.

During the investigation, LPA conducted interviews, toured facility, and reviewed files. LPA obtained copies of R1's incidents reports, eviction letter, care plans, and billing statements.

Report Continues on LIC9099-C

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Yvonne Flores-Larios
LICENSING EVALUATOR NAME: Alona Gomez
LICENSING EVALUATOR SIGNATURE:	DATE: 08/08/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/08/2025

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-20250130154001

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: 08/08/2025

NARRATIVE

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For the above allegations the following was found:
On 6/5/2025 LPA interviewed S1, S2, and S3. S1 and S2 both stated that they worked with R1 at some point during their stay. Both staff were knowledgeable of R1's behaviors, conditions, and daily needs. Both staff expressed that R1 had wandering behavior and that it got to a point of R1's family hiring an outside companion because staff were unable to provide 1:1 care to R1 to ensure their safety. LPA also observed that R1 had a complete and updated care plan. LPA was unable to identify where care was not adequately provided. During the investigation LPA obtained detailed billing information for R1's stay however LPA could not confirm or confirm if the family received a copy because there were no correspondences available regarding billing statements being sent. However LPA spoke with the Business Office Coordinator who states that billing statements are included as a part of the package when eviction notices are issued. LPA observed an eviction notice dated 10/22/2024. Upon evaluation of the billing statement LPA observed that resident was admitted in July of 2023 with a daily room rate of $189, medication level 1 of $25 per day, and level 2 care of $72 per day. On 1/1/2024 the rate increased to $207 per day for the room and $27 per day for level 1 medication assistance. According to the billing statement R1's rent was typically not paid on time so late fees were also assessed. The detailed bill shows that there is a remaining balance of $9,288 still owed to the facility, therefore it appears that no refund is do. Therefore the above allegations are Unsubstantiated.

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.

Exit interview conducted and a copy of report provided.

SUPERVISORS NAME: Yvonne Flores-Larios
LICENSING EVALUATOR NAME: Alona Gomez
LICENSING EVALUATOR SIGNATURE:	DATE: 08/08/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/08/2025

LIC9099 (FAS) - (06/04)

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