079200326-8-3-2022-15-AS-KHOS-CHBRK3-20220815130453

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 079200326
Report Date: 08/03/2022
Date Signed: 08/03/2022 03:31:27 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
07/29/2022 and conducted by Evaluator Catherine Lin

PUBLIC

COMPLAINT CONTROL NUMBER: 15-AS-20220729141930

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: 93	DATE:	08/03/2022
		UNANNOUNCED	TIME BEGAN:	11:00 AM
MET WITH:	Barbara Tudda, Executive Director		TIME COMPLETED:	03:10 PM

ALLEGATION(S):

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Facility is violating resident’s personal rights

INVESTIGATION FINDINGS:

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On 8/3/2022 at 11:00AM, Licensing Program Analyst (LPA) C. Lin arrived unannounced to conduct an initial 10-day complaint investigation in regard to the allegation above and delivered investigation findings. LPA met with Administrator Barbara Tudda and informed her the reason for visit.

The Department has investigated this allegation and per record review and interviews found that resident's physician's report (LIC 602) indicated that "Resident is unable to leave facility unassisted". Resident was found sat on the bench outside of the facility by self was considered elopement. Facility has right to implement higher level of supervisor to resident, according to resident's signed admission agreement at item 7(a) on page 13, Miscellaneous Provisions-Private Duty Personnel. "If we determine that: (ii) you have engaged in conduct that constitutes you as a wander risk, we reserve the right to retain 24-hour private duty personnel to provide care appropriate to your needs and you agree to be responsible for payment of the costs of such personnel."

Continue on LIC9099-C

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Bennett Fong	TELEPHONE: (510) -62-2621
LICENSING EVALUATOR NAME: Catherine Lin	TELEPHONE: 510-622-2053
LICENSING EVALUATOR SIGNATURE:	DATE: 08/03/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/03/2022

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-20220729141930

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: 08/03/2022

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32	Although the allegation may have happened or is valid, there is not a preponderance of evidence to provide the alleged violation did occur, therefore the allegation is UNSUBSTANTIATED. No deficiency cited. Exit interview conducted and a copy of this report provided to Administrator.

SUPERVISOR'S NAME: Bennett Fong	TELEPHONE: (510) -62-2621
LICENSING EVALUATOR NAME: Catherine Lin	TELEPHONE: 510-622-2053
LICENSING EVALUATOR SIGNATURE:	DATE: 08/03/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/03/2022

LIC9099 (FAS) - (06/04)

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