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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 079200326
Report Date: 09/05/2025
Date Signed: 09/05/2025 02:04:58 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
08/18/2025 and conducted by Evaluator David Doidge
COMPLAINT CONTROL NUMBER: 15-AS-20250818102737
FACILITY NAME:ATRIA PARK OF LAFAYETTEFACILITY NUMBER:
079200326
ADMINISTRATOR:ANTHONY, KAWANAFACILITY TYPE:
740
ADDRESS:1545 PLEASANT HILL RDTELEPHONE:
(925) 932-9910
CITY:LAFAYETTESTATE: CAZIP CODE:
94549
CAPACITY:130CENSUS: 91DATE:
09/05/2025
UNANNOUNCEDTIME BEGAN:
10:40 AM
MET WITH:Memory Care Director Susana ChavezTIME COMPLETED:
02:30 PM
ALLEGATION(S):
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Staff made inappropriately comment to resident in care.
INVESTIGATION FINDINGS:
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On 09/05/20245 at 10:40 AM, Licensing Program Analyst (LPA) David Doidge arrived unannounced to further investigate and deliver findings for the allegations above. Upon arrival, LPA met with Memory care Director Susana Chavez and explained the purpose of the visit.

During the course of the investigation, LPA interviewed six (6) staff, and four (4) residents. LPA also, obtained the following information: R1’s Physician’s Report (602), and staff roster.

Allegation: Staff made inappropriately comment to resident in care.

Investigation Finding: Based on staff and resident interviews this allegation is Unsubstantiated. LPA interviewed multiple staff and residents. Staff shared that residents can, at times, become stern in communication during care services.

Continued of LIC9099-C
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Bennett Fong
LICENSING EVALUATOR NAME: David Doidge
LICENSING EVALUATOR SIGNATURE:

DATE: 09/05/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/05/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 1 of 2
Control Number 15-AS-20250818102737
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: ATRIA PARK OF LAFAYETTE
FACILITY NUMBER: 079200326
VISIT DATE: 09/05/2025
NARRATIVE
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Continued from LIC9099

Staff have responded by asking that resident to be less stern, which could be perceived as inappropriate. Staff and residents recognize a lack of communication during one on one care can lead to misunderstandings.

Residents interviewed feel staff are friendly, kind, and have never seen staff be inappropriate to residents. Staff interviewed reported not seeing, hearing, nor themselves being inappropriate towards residents.

Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did occur, therefore the allegation that staff made inappropriately comment to resident in care is unsubstantiated.

No deficiencies observed during visit.

Exit interview conducted and a copy of this report provided.

SUPERVISORS NAME: Bennett Fong
LICENSING EVALUATOR NAME: David Doidge
LICENSING EVALUATOR SIGNATURE:

DATE: 09/05/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/05/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 2