079200382-3-30-2023-15-AS-YFLS-CRVQAQ-20230516120018

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 079200382
Report Date: 03/30/2023
Date Signed: 03/30/2023 05:40:49 PM

Unsubstantiated

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
11/29/2021 and conducted by Evaluator Lizette Francisco

PUBLIC

COMPLAINT CONTROL NUMBER: 15-AS-20211129095653

FACILITY NAME:	BROOKDALE DIABLO LODGE		FACILITY NUMBER:	079200382
ADMINISTRATOR:	GRADY, WILLIAM		FACILITY TYPE:	740
ADDRESS:	950 DIABLO ROAD		TELEPHONE:	(925) 838-8300
CITY:	DANVILLE	STATE: CA	ZIP CODE:	94526
CAPACITY:	128	CENSUS: 101	DATE:	03/30/2023
		UNANNOUNCED	TIME BEGAN:	02:15 PM
MET WITH:	Rachael Davis, Executive Director		TIME COMPLETED:	05:20 PM

ALLEGATION(S):

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Staff did not assist resident with her incontinence.
The temperature was below the regulated limit.

INVESTIGATION FINDINGS:

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On 3/30/23 at 2:15 PM, Licensing Program Analyst (LPA) L. Francisco arrived unannounced to conduct complaint investigation for the above allegations. LPA met with Executive Director, Rachael Davis and explained the purpose of the visit.

During the course of the investigation, LPA obtained information, collected documents and interviewed staff and residents. It was alleged staff did not assist resident with her incontinence. However, interview with 4 staff revealed residents are checked every two hours and if the call button has been pressed. 6 of 6 stated that staff check on them and staff responds to the call button. No forthcoming information was obtained from reporting party.

REPORT CONTINUES ON 9099C

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Harpreet Humpal	TELEPHONE: (510) 285-3928
LICENSING EVALUATOR NAME: Lizette Francisco	TELEPHONE: (510) 286-4201
LICENSING EVALUATOR SIGNATURE:	DATE: 03/30/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/30/2023

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-20211129095653

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: BROOKDALE DIABLO LODGE	FACILITY NUMBER: 079200382
	VISIT DATE: 03/30/2023

NARRATIVE

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It was alleged the temperature was below the regulated limit. Based on observation, each apartments have its own air conditioner and heating. On 12/6/2021, S1 stated resident's apartments are equipped with smart thermostat where the temperature is set between 65 degrees F and 81 degrees F, but most rooms are set at 72 degrees F. S1 stated if residents are not able to set their own thermostat, residents will call concierge to have staff set temperature for residents.

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

Exit interview conducted and a copy of this report provided to Executive Director.

SUPERVISOR'S NAME: Harpreet Humpal	TELEPHONE: (510) 285-3928
LICENSING EVALUATOR NAME: Lizette Francisco	TELEPHONE: (510) 286-4201
LICENSING EVALUATOR SIGNATURE:	DATE: 03/30/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/30/2023

LIC9099 (FAS) - (06/04)

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