079200575-2-17-2023-15-AS-KHOS-CPGLMA-20230228075225

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 079200575
Report Date: 02/17/2023
Date Signed: 02/17/2023 01:03:42 PM

Unfounded

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
02/10/2023 and conducted by Evaluator Daisy Panlilio

COMPLAINT CONTROL NUMBER: 15-AS-20230210093913

FACILITY NAME:	COMMONS AT DALLAS RANCH, THE		FACILITY NUMBER:	079200575
ADMINISTRATOR:	BRITTANY KARLINSKI		FACILITY TYPE:	740
ADDRESS:	4751 DALLAS RANCH ROAD		TELEPHONE:	(925) 754-7772
CITY:	ANTIOCH	STATE: CA	ZIP CODE:	94531
CAPACITY:	123	CENSUS: 83	DATE:	02/17/2023
		UNANNOUNCED	TIME BEGAN:	12:30 PM
MET WITH:	Brittany Karlinski, Executive Director		TIME COMPLETED:	01:15 PM

ALLEGATION(S):

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Facility does not ensure residents have meals in a designated dining area with other residents
Facility does not ensure planned social activities are available for residents in care

INVESTIGATION FINDINGS:

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On 02/17/23 at 12:30PM, LPA D Panlilio conducted an unannounced complaint visit, met with executive director (ED), explained the purpose of the visit, gathered information relevant to the allegations and delivered the findings.

Allegation: Facility does not ensure residents have meals in a designated dining area with other residents
Investigation Finding: Unfounded
ED stated that the facility has experienced positive staff and resident cases of COVID-19 in the past 6 months. Facility staff communicated and followed Local Public Health team's recommendations in ensuring that all COVID-19 mitigation protocols are strictly followed and that facility is in compliance with all COVID-19 infection controls.

Continued on next page, LIC 9099-C

Unfounded

Estimated Days of Completion:

SUPERVISOR'S NAME: Bennett Fong	TELEPHONE: (510) 622-2621
LICENSING EVALUATOR NAME: Daisy Panlilio	TELEPHONE: (510) 286-4201
LICENSING EVALUATOR SIGNATURE:	DATE: 02/17/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/17/2023

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-20230210093913

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: COMMONS AT DALLAS RANCH, THE	FACILITY NUMBER: 079200575
	VISIT DATE: 02/17/2023

NARRATIVE

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Facility staff also sent notifications/updates to residents and authorized representatives regarding COVID-19 quarantine status by mail. This includes the temporary suspension of communal dining for residents to mitigate the spread of COVID-19 infection.

This department had investigated the complaint alleging that facility does not ensure residents have meals in a designated dining area with other residents. We have found that the complaint was unfounded, meaning that the allegation is without reasonable basis. We have therefore dismissed the complaint.

Allegation: Facility does not ensure planned social activities are available for residents in care
Investigation Finding: Unfounded
When positive COVID-19 cases were confirmed by PCR and Antigen tests, ED stated that facility had to comply with Local Public Health's guidance to temporarily suspend planned social activities for residents in care to mitigate the spread of infection. This department had investigated the complaint alleging that facility does not ensure planned social activities are available for residents in care. We have found that the complaint was unfounded, meaning that the allegation is without reasonable basis. We have therefore dismissed the complaint.

No deficiencies cited. Exit Interview conducted and a copy of this report provided via email.

SUPERVISOR'S NAME: Bennett Fong	TELEPHONE: (510) 622-2621
LICENSING EVALUATOR NAME: Daisy Panlilio	TELEPHONE: (510) 286-4201
LICENSING EVALUATOR SIGNATURE:	DATE: 02/17/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/17/2023

LIC9099 (FAS) - (06/04)

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