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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 079200616
Report Date: 08/15/2024
Date Signed: 08/15/2024 04:30:12 PM

Unsubstantiated


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
11/15/2023 and conducted by Evaluator Tonica Syess-Gibson
PUBLIC
COMPLAINT CONTROL NUMBER: 15-AS-20231115143225
FACILITY NAME:LUCCHESI GROUP ADULT RESIDENTIAL CAREFACILITY NUMBER:
079200616
ADMINISTRATOR:VALADEZ, ARMANDOFACILITY TYPE:
735
ADDRESS:4739 LUCCHESI COURTTELEPHONE:
(925) 457-0913
CITY:OAKLEYSTATE: CAZIP CODE:
94561
CAPACITY:4CENSUS: 4DATE:
08/15/2024
UNANNOUNCEDTIME BEGAN:
04:00 PM
MET WITH:Anthony Valadez, House ManagerTIME COMPLETED:
04:39 PM
ALLEGATION(S):
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Client is being over-medicated at facility
Client has lost a lot of weight while in care
Client has fallen multiple times and sustained bruising while in care
INVESTIGATION FINDINGS:
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On 08/15/2024 at 4:00PM, Licensing Program Analyst (LPA), T.Syess-Gibson arrived unannounced to deliver complaint findings for the allegations above. LPA met with Anthony Valadez, House Manager and explained the reason for the visit.

During the course of the investigation, the Department interviewed staff, a witness, obtained and reviewed records. Based on the investigation the above allegations are unsubstantiated.

Allegation: Client is being over-medicated at facility
Based on interview and record review S1 is given medication as prescribed to C1 from the primary care physician. W1 stated during interview that at first, she felt C1 should not take the medication as prescribed but after observation she felt that the medication was needed but C1 could possibly be given a lesser dosage.
Continue on LIC9099C
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Harpreet Humpal
LICENSING EVALUATOR NAME: Tonica Syess-Gibson
LICENSING EVALUATOR SIGNATURE:

DATE: 08/15/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/15/2024
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 2
Control Number 15-AS-20231115143225
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: LUCCHESI GROUP ADULT RESIDENTIAL CARE
FACILITY NUMBER: 079200616
VISIT DATE: 08/15/2024
NARRATIVE
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Continue from LIC9099

LPA reviewed the centrally stored medication and destruction record and did not observe any discrepancies.

Allegation: Client has lost a lot of weight while in care.
Based on review of weight record from C1’s admission until January 2024, the record indicated C1 had continued weight loss. W1 stated that the weight loss was rapid but now is at a slow pace. S1 stated C1’s primary physician did not have a problem with the weight loss. The Department reviewed two (2) after summary visits that addressed C1’s weight loss and on January 16/2024, there was an issue that was addressed that could cause the weight loss; however, it was not fault of the facility.

Allegation: Client has fallen multiple times and sustained bruising while in care.
Based on interviews and review of incident reports it indicated C1 had fallen and sustained bruising multiple times. W1 stated during interview that most of C1’s falls occurs when C1 visit home on the weekends, and that possibly the falls are due to the dosage of medication. S1 stated during interview body checks are done and noted when C1 returns home from visit. S1 also stated that C1’s gait evaluation from Contra Costa Health that was conducted on August 31, 2023, shows instability which causes C1 to fall. Further record review from indicated a diagnosis that causes C1’s falls.

Although the allegations may have happened or is valid, there is 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.
SUPERVISORS NAME: Harpreet Humpal
LICENSING EVALUATOR NAME: Tonica Syess-Gibson
LICENSING EVALUATOR SIGNATURE:

DATE: 08/15/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/15/2024
LIC9099 (FAS) - (06/04)
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