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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 079200355
Report Date: 02/07/2025
Date Signed: 02/07/2025 12:04:59 PM

Substantiated


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
08/14/2024 and conducted by Evaluator Alona Gomez
COMPLAINT CONTROL NUMBER: 15-AS-20240814163008
FACILITY NAME:BROOKDALE SAN RAMONFACILITY NUMBER:
079200355
ADMINISTRATOR:FEASTER, NIARE DAWNFACILITY TYPE:
740
ADDRESS:18888 BOLLINGER CANYON RDTELEPHONE:
(925) 831-3964
CITY:SAN RAMONSTATE: CAZIP CODE:
94583
CAPACITY:110CENSUS: 80DATE:
02/07/2025
UNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Niare Feaster, Executive Director (ED)TIME COMPLETED:
12:35 PM
ALLEGATION(S):
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Facility not responding to resident's needs in a timely manner
INVESTIGATION FINDINGS:
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On 2/7/2025 at 9:30AM, 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 investigation LPA conducted interviews and reviewed available files. LPA spoke with the ED who acknowledges that the allegation "Facility not responding to resident's needs in a timely manner" is true at the time that the complaint was made. On 12/16/2024 LPA also interviewed S2, S3, and S4 who all felt that the facility is understaffed which leads to longer response times. Therefore the allegation is SUBSTANTIATED.

Based on LPAs observations and interviews which were conducted and record reviews, the preponderance of evidence standard has been met, therefore the above allegations are found to be SUBSTANTIATED. California Code of Regulations (Title 22, Division 6, Chapter 8), are being cited on the attached LIC 9099D.

Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Yvonne Flores-Larios
LICENSING EVALUATOR NAME: Alona Gomez
LICENSING EVALUATOR SIGNATURE:

DATE: 02/07/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/07/2025
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 4
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
08/14/2024 and conducted by Evaluator Alona Gomez
COMPLAINT CONTROL NUMBER: 15-AS-20240814163008

FACILITY NAME:BROOKDALE SAN RAMONFACILITY NUMBER:
079200355
ADMINISTRATOR:FEASTER, NIARE DAWNFACILITY TYPE:
740
ADDRESS:18888 BOLLINGER CANYON RDTELEPHONE:
(925) 831-3964
CITY:SAN RAMONSTATE: CAZIP CODE:
94583
CAPACITY:110CENSUS: DATE:
02/07/2025
UNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Niare Feaster, Executive Director (ED)TIME COMPLETED:
12:35 PM
ALLEGATION(S):
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9
Illegal eviction
Facility did not provide or assist in finding transportation for appointments
INVESTIGATION FINDINGS:
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On 2/7/2025 at 9:30AM, 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 investigation LPA conducted interviews and reviewed available files. ED states that R1 was not able to return to the facility because they had a stage 3 wound and that they told R1 the wound needed to heal before retuning. LPA interviewed R1 as well and R1 stated that the wound was staged at a 3 by one physician and a 2 by another.


Report continues on LIC9099-C
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Yvonne Flores-Larios
LICENSING EVALUATOR NAME: Alona Gomez
LICENSING EVALUATOR SIGNATURE:

DATE: 02/07/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/07/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 2 of 4
Control Number 15-AS-20240814163008
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: 02/07/2025
NARRATIVE
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LPA also interviewed the health and wellness director (HWD) who stated that R1 was told that they could not return to the facility with a stage 3 wound. ED and HWD both stated that the resident could return once the wound was no longer a stage 3. There was no documentation available for the LPA to review the official diagnosis of the wound. Title 22 states, "(a)Persons who require health services for or have a health condition including, but not limited to, those specified below shall not be admitted or retained in a residential care facility for the elderly:(1)Stage 3 and 4 pressure injuries". R1 never received an official eviction letter and relatives removed R1's belongings. Therefore the allegation "Illegal eviction" is UNSUBSTANTIATED.

During the course of the investigation LPA found through interviews with the ED, R1, and HWD that between the facility van with a lift was down. This van was the primary source of transportation for wheelchair residents. However the ED showed LPA receipts of Uber's that were scheduled for R1. Uber did cancel multiple rides due to not having wheelchair accessible vehicles. However the facility made multiple attempts to assist R1 with getting to their appointments. R1 states that they eventually found their own transportation that they paid for. A review of R1's admissions agreement and handbook showed that the facility does not guarantee transportation but that they will assist in making arrangements which the facility did. Therefore the allegation "Facility did not provide or assist in finding transportation for appointments" is UNSUBSTANTIATED.


Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegations are UNSUBSTANTIATED
SUPERVISORS NAME: Yvonne Flores-Larios
LICENSING EVALUATOR NAME: Alona Gomez
LICENSING EVALUATOR SIGNATURE:

DATE: 02/07/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/07/2025
LIC9099 (FAS) - (06/04)
Page: 3 of 4
Control Number 15-AS-20240814163008
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
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/07/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
02/07/2025
Section Cited
CCR
87411(a)
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(a) Facility personnel shall at all times be sufficient in numbers, and competent to provide the services necessary...of adequate services.

This requirement is not met as evidence by:
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ED states that the facility now has low response times for clients and understands the importance of timely responses. POC cleared.
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Based on interviews the facility did not comply with the regulation above by not providing adequete services to residents requesting assistance which posed a potential personal rights violation to residents in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISORS NAME: Yvonne Flores-Larios
LICENSING EVALUATOR NAME: Alona Gomez
LICENSING EVALUATOR SIGNATURE:

DATE: 02/07/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/07/2025
LIC9099 (FAS) - (06/04)
Page: 4 of 4