079200382-3-30-2023-15-AS-YFLS-CWJST6-20231012140900

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 079200382
Report Date: 03/30/2023
Date Signed: 03/30/2023 05:38:01 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
09/06/2022 and conducted by Evaluator Lizette Francisco

PUBLIC

COMPLAINT CONTROL NUMBER: 15-AS-20220906133730

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:	05:50 PM

ALLEGATION(S):

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Facility does not have proper provisions for residents in the event of a power outage

INVESTIGATION FINDINGS:

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On 3/30/2023 starting at 2:15 PM, Licensing Program Analyst (LPA) L. Francisco arrived unannounced to deliver findings for the above allegation. 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, interviewed staff and residents. It was alleged facility does not have proper provisions for residents in the event of a power outage. However, based on record review and interview, Emergency Disaster Plan was implemented during the power outtage. LPA discovered during an interview with 2 residents that the power outtage occured late at night and residents were provided back-up oxygen tanks.

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 allegation is UNSUBSTANTIATED.

Exit interview conducted and a copy of this report provided.

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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