079200326-12-20-2024-15-AS-HHUL-DCXN9A-20250115091539

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 079200326
Report Date: 12/20/2024
Date Signed: 12/20/2024 12:05:09 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
06/18/2024 and conducted by Evaluator Jill Clancy-Czuleger

COMPLAINT CONTROL NUMBER: 15-AS-20240618132309

FACILITY NAME:	ATRIA PARK OF LAFAYETTE		FACILITY NUMBER:	079200326
ADMINISTRATOR:	QUINLAN-TUDDA, BARBARA		FACILITY TYPE:	740
ADDRESS:	1545 PLEASANT HILL RD		TELEPHONE:	(925) 932-9910
CITY:	LAFAYETTE	STATE: CA	ZIP CODE:	94549
CAPACITY:	130	CENSUS: 78	DATE:	12/20/2024
		UNANNOUNCED	TIME BEGAN:	10:30 AM
MET WITH:	Robert Gomez, Executive Director		TIME COMPLETED:	12:30 PM

ALLEGATION(S):

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Resident sustained severe injury due to staff neglect resulting in death
Staff did not respond to resident's call button in a timely manner
Staff did not prevent resident from having bed bugs
Staff are not providing adequate food service to residents

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) J. Clancy-Czuleger arrived unannounced to deliver findings on the above allegation. LPA met Robert Gomez, Executive Director and explained the purpose of the visit.

On the allegation: Resident sustained severe injury due to staff neglect resulting in death.
The Department reviewed records and conducted interviews. Resident (R1) had a fall on March 28th 2023 at 4:25pm. Staff were present in the activities room with R1 but was not facing her when the fall occurred. R1’s medical records showed that there was no injury from the fall, but the hospital did additional testing and R1 was discharged on March 31st, 2023. R1 was readmitted to the hospital on 4/11/23 and admitted to hospice on 4/15/23, listing protein calorie malnutrition and Odynophagia, Diastolic CHF, Right Coronary Artery Disease, Atrial Fibrillation. R1 passed away 4/24/2023 and the immediate causes of death listed are cardiopulmonary arrest (onset seconds), myocardial infarction (onset minutes), and atherosclerosis (onset years). This allegation is unsubstantiated.

Continued on LIC9099-C...

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Harpreet Humpal	TELEPHONE: (510) 285-3928
LICENSING EVALUATOR NAME: Jill Clancy-Czuleger	TELEPHONE: 510-286-4201
LICENSING EVALUATOR SIGNATURE:	DATE: 12/20/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/20/2024

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-20240618132309

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: ATRIA PARK OF LAFAYETTE	FACILITY NUMBER: 079200326
	VISIT DATE: 12/20/2024

NARRATIVE

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...Continued from LIC 9099

On the allegation: Staff did not respond to resident's call button in a timely manner.

LPA spoke with staff (S1) who stated that they do not keep an archive of calls from the call buttons, and they no longer have the records from 2023. Review of current call button logs indicated that the average call button response time is 6 minutes and 9 seconds. This allegation is unsubstantiated.

On the allegation: Staff did not prevent resident from having bed bugs.

LPA spoke with S1 who stated that they have not had any resent situations involving bed bugs or any other insects. S1 stated that if they were to have any sort of report of bugs/pest from the residents they would contact their contracted pest control company to do come to do additional services on top of the quarterly preventative services they are already scheduled for. R1’s medical records have no mention of bug bites on resident. This allegation is unsubstantiated.

On the allegation: Staff are not providing adequate food service to residents

During investigation, LPA interviewed staff (ED, S1, S2) who stated they purchase food supplies for clients’ meals every week and prepare meals as scheduled on their weekly meal plans. Residents (R2, R3, R4) confirmed with LPA that staff provide them with adequate meals and that they are satisfied with the food service. Therefore, the allegation that staff are not providing adequate food service to residents is unsubstantiated.

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

SUPERVISOR'S NAME: Harpreet Humpal	TELEPHONE: (510) 285-3928
LICENSING EVALUATOR NAME: Jill Clancy-Czuleger	TELEPHONE: 510-286-4201
LICENSING EVALUATOR SIGNATURE:	DATE: 12/20/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/20/2024

LIC9099 (FAS) - (06/04)

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