079200355-8-19-2024-15-AS-KHOS-D97J6V-20240917064657

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 079200355
Report Date: 08/15/2024
Date Signed: 08/19/2024 08:18:20 AM

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
03/13/2024 and conducted by Evaluator Alona Gomez

COMPLAINT CONTROL NUMBER: 15-AS-20240313143757

FACILITY NAME:	BROOKDALE SAN RAMON		FACILITY NUMBER:	079200355
ADMINISTRATOR:	FEASTER, NIARE DAWN		FACILITY TYPE:	740
ADDRESS:	18888 BOLLINGER CANYON RD		TELEPHONE:	(925) 831-3964
CITY:	SAN RAMON	STATE: CA	ZIP CODE:	94583
CAPACITY:	110	CENSUS: 78	DATE:	08/15/2024
		UNANNOUNCED	TIME BEGAN:	12:00 PM
MET WITH:	Niare Feaster, Executive Director		TIME COMPLETED:	01:40 PM

ALLEGATION(S):

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Staff made resident move rooms
Staff is threatening resident with eviction
Staff are not meeting resident's needs

INVESTIGATION FINDINGS:

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On this day at around 12:00 pm, Licensing Program Analyst (LPA) A Gomez arrived unannounced to conduct an investigation and deliver findings. LPA met with Niare Feaster, Executive Director (ED).

During the course of the investigations LPA conducted interviews and reviewed files. On the allegation of staff made resident move rooms LPA interviewed R1, R2, and R3. All residents agreed that ED offers rooms that become available with a better rate but never forces them to move rooms. All residents stated that if they moved rooms it is because they wanted to. On the allegation of Staff threatening resident with Eviction LPA interviewed R1, ED, and S1. R1 states that the ED mentioned eviction during meal time and that the ED spoke with them and their brother about the eviction. ED states that they did speak with the brother about the eviction after R1 requested the conversation and that coversation happened privately in R1's apartment. ED states that the eviction wasn't mentioned during a meal time but that rather all eviction notifications are done via letter directly sent from coorporate to clients mailbox.
Report continues on LIC9099-C

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Yvonne Flores-Larios	TELEPHONE: (510) -28-0517
LICENSING EVALUATOR NAME: Alona Gomez	TELEPHONE: 510-239-1306
LICENSING EVALUATOR SIGNATURE:	DATE: 08/15/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/15/2024

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-20240313143757

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: BROOKDALE SAN RAMON	FACILITY NUMBER: 079200355
	VISIT DATE: 08/15/2024

NARRATIVE

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ED states that eviction letters resemble a bill and when LPA interviewed R1 they stated that they got a bill not an eviction letter. LPA also interviewed S1 who stated that they have never heard staff speak to any residents directly about being evicted. S1 states that they do recall a conversation with R1 and the topic of eviction but that R1 was talking to other residents about it during meal time. R2 and R3 do not recall hearing about a resident being evicted.

On the allegation of staff not meeting residents needs LPA interviewed R1, R2, and R3. R2 and R3 both felt that their needs are met at the facility. When LPA interviewed R1 it was found that R1 felt that their needs were not being met but that it was their personal caregiver that was supposed to be providing a 1:1 that was not meeting their needs and that they had no complaints with the facility staff.

LPA also obtained a copy of what an eviction notice looks like for reference.

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

SUPERVISOR'S NAME: Yvonne Flores-Larios	TELEPHONE: (510) -28-0517
LICENSING EVALUATOR NAME: Alona Gomez	TELEPHONE: 510-239-1306
LICENSING EVALUATOR SIGNATURE:	DATE: 08/15/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/15/2024

LIC9099 (FAS) - (06/04)

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