079200326-10-21-2025-15-AS-BFOG-DN5TXJ-20251105140714

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 079200326
Report Date: 10/21/2025
Date Signed: 10/21/2025 05:15:57 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
10/13/2025 and conducted by Evaluator David Doidge

COMPLAINT CONTROL NUMBER: 15-AS-20251013153349

FACILITY NAME:	ATRIA PARK OF LAFAYETTE		FACILITY NUMBER:	079200326
ADMINISTRATOR:	ANTHONY, KAWANA		FACILITY TYPE:	740
ADDRESS:	1545 PLEASANT HILL RD		TELEPHONE:	(925) 932-9910
CITY:	LAFAYETTE	STATE: CA	ZIP CODE:	94549
CAPACITY:	130	CENSUS: 82	DATE:	10/21/2025
		UNANNOUNCED	TIME BEGAN:	10:40 AM
MET WITH:	Community Business Director Grace Abaeg		TIME COMPLETED:	05:30 PM

ALLEGATION(S):

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Staff violated resident's personal rights

INVESTIGATION FINDINGS:

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On 10/20/2025 at 10:40 AM, Licensing Program Analyst (LPA) David Doidge arrived unannounced to conduct an initial 10-day complaint investigation and deliver findings in regards to the allegation above. LPA met with Community Business Director Grace Abaeg and explained the reason for the visit.

During the course of the investigation, LPA obtained and reviewed resident roster, staff roster and staff schedule for October, as well as the Physician’s Report (602), Notification of Incident or Change in Condition forms, and Functional Needs Assessment for R1. LPA interviewed R1, W1, S1, S2, S3, S4, S5. S6 was interviewed by phone.

Allegations: Staff violated resident's personal rights.

Continued on LIC 90099-C

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Bennett Fong
LICENSING EVALUATOR NAME: David Doidge
LICENSING EVALUATOR SIGNATURE:	DATE: 10/21/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/21/2025

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-20251013153349

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: 10/21/2025

NARRATIVE

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Continued from LIC9099
Investigation Finding: It was reported to the department that a male caregiver touched R1’s breast in an inappropriate manner. R1 reported the incident to her private companion through UPLIFT Home Care Agency, who then reported the incident to the owner of UPLIFT, who ultimately reported it to CCLD. LPA interviewed R1 in R1’s room. W1 was present and would not leave during interview. R1 felt more comfortable with W1 present, and W1 did not want R1 to be interviewed alone despite LPA asking W1 for some privacy for the interview.

R1 told LPA that a male caregiver, who’s name R1 could not readily remember, assisted R1 back from a common room where R1 and other residents were watching a movie. R1 said the caregiver took R1 by the arm and led R1 up 6 steps and down the hall to R1’s room. At the door R1 informed the caregiver that R1 did not need further assistance. R1 said the caregiver insisted on assisting in removing R1’s blouse. While removing the blouse, the caregiver touched R1’s breast making R1 feel uncomfortable. When LPA asked R1 if R1 could remember any features, or the name of the caregiver, R1 hesitated, as if to think, and W1 prompted R1 with a name. R1 thought about it, then repeated the name. R1 said R1 sees the caregiver from time to time around the facility prompting W1 to say this is how W1 knows the name of the caregiver. R1 did not seem to really know it was in fact that caregiver. R1 is certain it was a male caregiver. W1 was more certain.

LPA interviewed W1 in the hallway. W1 feels R1 gave a detailed description of the event and, although R1 has some memory issues with time, W1 thinks R1 remembers the event well enough.

LPA interviewed S1 who was present the day in question as well as the day before. S1 reported that R1 has been found on multiple occasions wandering around the facility and forgetful as to why R1 was out in the halls and where R1 was going. S1 recalled that the day before, another caregiver S4, had to walk R1 back to R1’s room after staff saw R1 wandering the hallway appearing disoriented and with a lean to R1’s walk. S4 informed LPA that S4 had the day before assisted R1 back to R1’s room from the other side of the building, but on the same floor.

Continued on LIC9099-C

SUPERVISORS NAME: Bennett Fong
LICENSING EVALUATOR NAME: David Doidge
LICENSING EVALUATOR SIGNATURE:	DATE: 10/21/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/21/2025

LIC9099 (FAS) - (06/04)

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Control Number 15-AS-20251013153349

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: 10/21/2025

NARRATIVE

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Continued form LIC9099-C

S4 walked R1 back into R1’s room and left. S1 then radioed S4 and asked S4 to check on R1 as S1 felt R1 needed to be checked on. S4 entered R1’s room and asked R1 if R1 would like assistance getting ready for bed. R1 agreed, and S4 went to grab R1’s bed clothes. While bringing over the clothes, R1 took R1’s own top and underwear off unassisted. S4 handed R1 the clean clothes but did not touch R1. S4 offered R1 S4’s hand to get out of the chair. S4 then guided, from behind, R1 to bed, lifted R1’s legs onto the bed, and left. S1 confirmed S! asked S4 to assist in that manner. S4 is not the caregiver R1 named as the one who touched R1. The named caregiver, S6, worked NOC shift that night. LPA interviewed S6 by phone. S6 informed LPA S6 did not interact with R1 that night but had in the past gone into R1’s room to clear a Pedant alarm.

S2, S3, and S5 have all interacted with R1. Each have reported that R1 confuses easily and will wander out of R1’s room at different hours both day and night. Neither S2, S3, nor S5 witnessed anything. No staff interviewed by LPA witnessed any interaction between a caregiver and R1 that appeared inappropriate in nature. S5 is usually assigned R1 in the evenings. S5 does not assist R1 with changing.

S5 informed LPA that R1 did not need assisting the day of. S5 was not on shift the night before when S4 assisted. The night before S4 was assigned to cover R1. Based on interviews and no corroboration of the incident, the allegation is unsubstantiated.

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.

SUPERVISORS NAME: Bennett Fong
LICENSING EVALUATOR NAME: David Doidge
LICENSING EVALUATOR SIGNATURE:	DATE: 10/21/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/21/2025

LIC9099 (FAS) - (06/04)

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