079200326-3-24-2025-15-AS-KHOS-DFHHTQ-20250407062907

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 079200326
Report Date: 03/24/2025
Date Signed: 03/24/2025 03:49:05 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
10/23/2023 and conducted by Evaluator Kelly Nguyen

COMPLAINT CONTROL NUMBER: 15-AS-20231023143344

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: 88	DATE:	03/24/2025
		UNANNOUNCED	TIME BEGAN:	12:20 PM
MET WITH:	Corrine Tanchoco, Excutive Director		TIME COMPLETED:	04:00 PM

ALLEGATION(S):

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Due to neglect/lack of supervision, resident sustained multiple unexplained bruises while in care.
Staff did not provide resident with pain medication.
Staff did not safeguard resident's personal belongings.

INVESTIGATION FINDINGS:

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On 3/24/2025 at 12:20 p.m. Licensing Program Analyst (LPA) K. Nguyen conducted an unannounced visit to deliver the findings for the above complaint allegations. LPA met with Executive Director, Corrine Tanchoco(ED) explained the purpose of the visit.

Allegation: Neglect/Lack of Care: Due to neglect/lack of care, resident sustained multiple unexplained bruises while in care.

Report continue on LIC 9099c...

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Bennett Fong	TELEPHONE: (510) 725-7919
LICENSING EVALUATOR NAME: Kelly Nguyen	TELEPHONE: (510) 915-8702
LICENSING EVALUATOR SIGNATURE:	DATE: 03/24/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/24/2025

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-20231023143344

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: 03/24/2025

NARRATIVE

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Finding: Unsubstantiated

During the investigation, the department conducted residents and staff interviews, obtained and reviewed R1’s including medical records, Suncrest Hospice Records, care notes, death Certificate.
On 09/08/2023, R1 fell out of her bed and sustained bruising to R1 chest and back. Staff did not call 911 and called Suncrest hospice to have R1 assessed for injuries. The hospice stated that R1 did not have any injuries after her initial fall. Staff admitted that R1 was a fall risk due to her “wiggling” out of R1 wheelchair. Staff confirmed that R1 never fell out of Hoyer lift, was never transferred by one caregiver, and was a two person assist. Staff admitted that they would place R1 in the middle of the bed and face R1 toward the wall so that R1 would not fall out of the bed. S7 admitted that R1 bruises came from R1 falling out of her bed at the facility.

Allegation: Staff did not provide resident with pain medication

Finding: Unsubstantiated

On 9/9/2023, 9/13/2023, 9/14/2023, 9/18/24, 9/20/2023, 9/21/2023, and 9/24/2024 Skilled nursing visit stated R1 seemed comfortable with no indication of pain. R1 did not have a routine pain medication. On 9/12/2023 Medical Social Worker (MSW)- Visit Notes- Observed to be well groomed and no pain behavioral issues. Care staff (S2 and S3) stated “With R1 we are trained to observed R1 pain by, R1 body language, and facial expression. During those time that S2 and S3 are assisting R1 if S2, and S3 noticed R1 have anybody/ facial expression of pain they would notify Med-techs (S4 and S5) right away. S4 stated when S4 are notified by S2 or S3 S4 would attend to R1 with a floor Nurse and evaluate R1 pain level, and if R1 need PRN(Tylenol) we would provide that, but there’s no doctor ordered on a given time of PRN (as needed). S4 stated if our nurse evaluate R1 need morphine S4/ floor nurse would contact Hospice Nurse because R1 is on Hospice, and they need to give permission. S4 stated there was not a time that R1 is in pain and was not provided with pain medication.

Report continue on LIC 9099c...

SUPERVISOR'S NAME: Bennett Fong	TELEPHONE: (510) 725-7919
LICENSING EVALUATOR NAME: Kelly Nguyen	TELEPHONE: (510) 915-8702
LICENSING EVALUATOR SIGNATURE:	DATE: 03/24/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/24/2025

LIC9099 (FAS) - (06/04)

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Control Number 15-AS-20231023143344

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: 03/24/2025

NARRATIVE

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Allegation: Staff did not safeguard resident's personal belongings.

Finding: Unsubstantiated

During the investigation, the department conducted residents and staff interviews.

The department interviewed S2, S3, S7, and S8, all four staff was working with R1. 4 out of 4 stated that there was not a time that R1 have anything missing. They have not heard any complaint from R1 family members. 4 out of 4 stated they did not see R1 wearing anyone else clothing, nor left R1 sleeping on the bed without any bedsheet.

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.

Exit interview conducted and a report provided to ED.

SUPERVISOR'S NAME: Bennett Fong	TELEPHONE: (510) 725-7919
LICENSING EVALUATOR NAME: Kelly Nguyen	TELEPHONE: (510) 915-8702
LICENSING EVALUATOR SIGNATURE:	DATE: 03/24/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/24/2025

LIC9099 (FAS) - (06/04)

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