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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 079200375
Report Date: 05/29/2024
Date Signed: 05/29/2024 05:03:06 PM

Substantiated


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
04/09/2024 and conducted by Evaluator Jill Clancy-Czuleger
COMPLAINT CONTROL NUMBER: 15-AS-20240409090155
FACILITY NAME:BETHANY HOME CONCORDFACILITY NUMBER:
079200375
ADMINISTRATOR:ARPAD NAGYFACILITY TYPE:
740
ADDRESS:3815 CONCORD BLVD.TELEPHONE:
(925) 640-6403
CITY:CONCORDSTATE: CAZIP CODE:
94519
CAPACITY:6CENSUS: 4DATE:
05/29/2024
UNANNOUNCEDTIME BEGAN:
03:04 PM
MET WITH:Arpad Nagy, LicenseeTIME COMPLETED:
05:20 PM
ALLEGATION(S):
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9
Staff not informing Responsible Party of resident’s changes in condition
No Administrator at facility on a regular basis
Administrator qualifications
Facility does not have grab bars for resident in bathroom
Staff not ensuring resident receiving proper medical care

INVESTIGATION FINDINGS:
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On 05/29/2024 at 2:35 PM, Licensing Program Analysts (LPAs) J. Clancy-Czuleger arrived unannounced to deliver findings for the above allegations. LPA explained the purpose of the visit with House Manager Telesha Clarke. Licensee Arpad Nagy was called and joined later.

During the course of investigation, LPA obtained information, collected documents, and interviewed staff and residents.

On the allegation facility Staff not informing Responsible Party of resident’s changes in condition. Based on record review and interviews the facility did not inform R1’s responsible party that whenever there was a change of condition with R1 or a when they were having trouble getting a prescription from the pharmacy.

Continued on LIC9099-C...
Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Harpreet HumpalTELEPHONE: (510) 285-3928
LICENSING EVALUATOR NAME: Jill Clancy-CzulegerTELEPHONE: 510-286-4201
LICENSING EVALUATOR SIGNATURE:

DATE: 05/29/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/29/2024
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 7
Control Number 15-AS-20240409090155
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: BETHANY HOME CONCORD
FACILITY NUMBER: 079200375
VISIT DATE: 05/29/2024
NARRATIVE
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...Continued from LIC9099

On the allegation No Administrator at facility on a regular basis. Based on record review and interviews the facility administrator does not come to the facility. Residents, staff, and residents’ families believe that S1 is the administrator, and most residents and resident families are unaware of who S3 is.

On the allegation administrator qualifications. Based on record review the facility administrator is currently listed as administrator to a total of four licensed facilities and has an application in for a fifth. When LPA asked for the LIC 500 S3 was not listed having any hours at the facility or on the LIC 500 at all.

On the allegation facility does not have grab bars for resident in bathroom. The facility was licensed with three bathrooms. One bathroom is in a private room, one is at the back of the house and one in by the front of the house. The bathroom at the back of the house has a non-permeant/movable grab bar, the front bathroom has a permeant grab bar across from the toilet that is out of reach.

On the allegation facility staff not ensuring resident receiving proper medical care. Based on record review and interviews the facility has not taken R1 to get an updated annual physician’s report since June 2022.


Based on LPAs interviews, the preponderance of evidence standard has been met, therefore the above allegation is found to be SUBSTANTIATED. California Code of Regulations (Title 22, Division 6, Chapter 8), is being cited on the attached LIC 9099D.

Exit interview conducted. Appeal Rights and a copy of this report provided.
SUPERVISOR'S NAME: Harpreet HumpalTELEPHONE: (510) 285-3928
LICENSING EVALUATOR NAME: Jill Clancy-CzulegerTELEPHONE: 510-286-4201
LICENSING EVALUATOR SIGNATURE:

DATE: 05/29/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/29/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 7
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
04/09/2024 and conducted by Evaluator Jill Clancy-Czuleger
COMPLAINT CONTROL NUMBER: 15-AS-20240409090155

FACILITY NAME:BETHANY HOME CONCORDFACILITY NUMBER:
079200375
ADMINISTRATOR:ARPAD NAGYFACILITY TYPE:
740
ADDRESS:3815 CONCORD BLVD.TELEPHONE:
(925) 640-6403
CITY:CONCORDSTATE: CAZIP CODE:
94519
CAPACITY:6CENSUS: 4DATE:
05/29/2024
UNANNOUNCEDTIME BEGAN:
03:04 PM
MET WITH:Arpad Nagy, LicenseeTIME COMPLETED:
05:20 PM
ALLEGATION(S):
1
2
3
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5
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7
8
9
Staff not administering all doses of resident’s medications
Administrator punishes resident
Administrator yells at the staff and at the residents
Facility does not have a dedicated phone line
Staff living in garage at the facility
Staff not bathing resident in an appropriate manner
Staff feeding residents unhealthy food.
INVESTIGATION FINDINGS:
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On 05/29/2024 at 2:35 PM, Licensing Program Analysts (LPAs) J. Clancy-Czuleger arrived to deliver findings for above allegations. LPA explained the purpose of the visit with House Manager Telesha Clarke. Licensee Arpad Nagy was called and joined later.

On the allegation facility Staff living in garage at the facility. Based on record review and interviews the facility does have a room on the floorplan that is dedicated to staff in the garage. This room has fire clearance.

On the allegation facility Staff feeding residents unhealthy food. The facility is well stocked with a varity of health foods, and they have a menu that they update regularly.

On the allegation facilitydoes not have a dedicated phone line. Based on observation the facility does have a dedicated phone line at the facility. The facility primarily gives out the house managers direct line instead of the land line, so the phone is not ringing all day long.
Continued on LIC9099-C...
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Harpreet HumpalTELEPHONE: (510) 285-3928
LICENSING EVALUATOR NAME: Jill Clancy-CzulegerTELEPHONE: 510-286-4201
LICENSING EVALUATOR SIGNATURE:

DATE: 05/29/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/29/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 3 of 7
Control Number 15-AS-20240409090155
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: BETHANY HOME CONCORD
FACILITY NUMBER: 079200375
VISIT DATE: 05/29/2024
NARRATIVE
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...Continued from LIC9099-A

On the allegation facility Administrator yells at the staff and at the residents. Based on record review and interviews the administrator does not come to the facility.

On the allegation facility administrator punishes resident. Based on record review and interviews the facility administrator does not come to the facility.

On the allegation facility Staff not administering all doses of resident’s medications. Based on record review and interviews the facility does not have a medication log of each dosage given to the residents.

On the allegation facility staff not bathing resident in an appropriate manner. Based on interviews R1 has requested that only female staff assist with bathing. In interview with S1 they state that they were never informed of this preference.

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

Exit interview conducted and a copy of this report provided.
SUPERVISOR'S NAME: Harpreet HumpalTELEPHONE: (510) 285-3928
LICENSING EVALUATOR NAME: Jill Clancy-CzulegerTELEPHONE: 510-286-4201
LICENSING EVALUATOR SIGNATURE:

DATE: 05/29/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/29/2024
LIC9099 (FAS) - (06/04)
Page: 4 of 7
Control Number 15-AS-20240409090155
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: BETHANY HOME CONCORD
FACILITY NUMBER: 079200375
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/29/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
05/31/2024
Section Cited
CCR
87405(b)
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The administrator of a facility or facilities shall have the responsibility and authority to carry out the policies of the licensee. This requirement is not met as evidenced by:
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The licensee agrees to review the responsibilities of the administrator with the administrator. Proof of correction will be sent to CCLD by POC date.
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Based on observation, the licensee did not comply with the section cited above by having the house manager preform the duties of administrator without an administrator license which poses an immediate health and safety risk to persons in care.
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Type A
05/31/2024
Section Cited
CCR
87405(a)
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All facilities shall have a qualified and currently certified administrator... The administrator shall have sufficient freedom from other responsibilities and shall be on the premises a sufficient number of hours to permit adequate attention to the management and administration of the facility as specified in this section... This requirement is not met as evidenced by:
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The facility has staff signed up for administrator coruses. The facility agrees to send proof that the staff is signed up for the classes. Proof of correction will be sent to CCLD by POC date
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Based on records review and observation, the licensee did not comply with the section cited above by not having the administrator at the facility for a sufficient number of hours which poses an immediate health and safety risk to persons 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.
SUPERVISOR'S NAME: Harpreet HumpalTELEPHONE: (510) 285-3928
LICENSING EVALUATOR NAME: Jill Clancy-CzulegerTELEPHONE: 510-286-4201
LICENSING EVALUATOR SIGNATURE:

DATE: 05/29/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/29/2024
LIC9099 (FAS) - (06/04)
Page: 5 of 7
Control Number 15-AS-20240409090155
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: BETHANY HOME CONCORD
FACILITY NUMBER: 079200375
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/29/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
05/31/2024
Section Cited
CCR
87468.1(a)(8)
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Residents in all residential care facilities ... following personal rights: To have their representatives regularly informed by the licensee of activities related to care or services, including ongoing evaluations, as appropriate to their needs. This requirement is not met as evidenced by:
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Licensee agrees to review the regulations and send self-certification to CCLD by POC date.
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Based on observation, the licensee did not comply with the section cited above by not informing R1’s responsible party of changes which poses an immediate health and safety risk to persons in care.
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Type A
06/05/2024
Section Cited
CCR
87705(c)(5)
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Each resident with dementia shall have an annual medical assessment as specified in Section 87458, Medical Assessment, and a reappraisal done at least annually, both of which shall include a reassessment of the resident’s dementia care needs. This requirement is not met as evidenced by:
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Licensee agrees to review all residents Physicians reports and schedule appointments to updated all residents with a diagnoses of dementia. Proof of correction will be sent to CCLD by POC date.
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Based on observation, the licensee did not comply with the section cited above by not having an annual medical assessment for R1 since 2022 which poses an immediate health and safety risk to persons 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.
SUPERVISOR'S NAME: Harpreet HumpalTELEPHONE: (510) 285-3928
LICENSING EVALUATOR NAME: Jill Clancy-CzulegerTELEPHONE: 510-286-4201
LICENSING EVALUATOR SIGNATURE:

DATE: 05/29/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/29/2024
LIC9099 (FAS) - (06/04)
Page: 6 of 7
Control Number 15-AS-20240409090155
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: BETHANY HOME CONCORD
FACILITY NUMBER: 079200375
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/29/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
06/28/2024
Section Cited
CCR
87303(e)(4)
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Grab bars shall be maintained for each toilet; bathtub and shower used by residents. This requirement is not met as evidenced by:
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The facility agrees to install grab bars in the bathrooms in reach of the toilets. Proof of correction will be sent to CCLD by POC date.
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Based on observation, the licensee did not comply with the section cited above by having a grab bar that it out of reach for resident to use which poses an immediate health and safety risk to persons 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.
SUPERVISOR'S NAME: Harpreet HumpalTELEPHONE: (510) 285-3928
LICENSING EVALUATOR NAME: Jill Clancy-CzulegerTELEPHONE: 510-286-4201
LICENSING EVALUATOR SIGNATURE:

DATE: 05/29/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/29/2024
LIC9099 (FAS) - (06/04)
Page: 7 of 7