079200855-5-14-2024-15-AS-HHUL-D7PSB6-20240731134325

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 079200855
Report Date: 05/14/2024
Date Signed: 05/14/2024 01:07:11 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
11/28/2023 and conducted by Evaluator Jill Clancy-Czuleger

COMPLAINT CONTROL NUMBER: 15-AS-20231128160340

FACILITY NAME:	TREVISTA CONCORD		FACILITY NUMBER:	079200855
ADMINISTRATOR:	THAMES, LORI		FACILITY TYPE:	740
ADDRESS:	1081 MOHR LN		TELEPHONE:	(925) 798-3900
CITY:	CONCORD	STATE: CA	ZIP CODE:	94518
CAPACITY:	160	CENSUS: 96	DATE:	05/14/2024
		UNANNOUNCED	TIME BEGAN:	11:00 AM
MET WITH:	Siobhan Lehman,Executive Director		TIME COMPLETED:	01:30 PM

ALLEGATION(S):

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Staff do not ensure unsafe furniture is removed from the facility.
Staff do not ensure the facility is kept in clean, safe, sanitary conditions at all times for residents in care.
Staff do not ensure food is properly stored and prepared safely for residents.
Staff do not ensure adequate food portions are provided to residents.
Staff does not ensure facility is kept in good repair at all times.

INVESTIGATION FINDINGS:

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On 5/14/2024 at 11:00AM, Licensing Program Analysts (LPAs) J. Clancy-Czuleger arrived unannounced to deliver findings for the above allegations. LPA explained the purpose of the visit with Executive Director, Siobhan Lehman.

On the allegation facility Staff do not ensure the facility is kept in clean, safe, sanitary conditions at all times for residents in care. Based on interviews and observation the facility does appear to be clean. The tables in the dining room are cleaned after each meal.

On the allegation facility Staff do not ensure food is properly stored and prepared safely for residents. Based on observation and interviews the facility keep proper food portions for each meal for each resident.

Continued on 9099C...

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Harpreet Humpal	TELEPHONE: (510) 285-3928
LICENSING EVALUATOR NAME: Jill Clancy-Czuleger	TELEPHONE: 510-286-4201
LICENSING EVALUATOR SIGNATURE:	DATE: 05/14/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/14/2024

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-20231128160340

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: TREVISTA CONCORD	FACILITY NUMBER: 079200855
	VISIT DATE: 05/14/2024

NARRATIVE

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....Continued from 9099

On the allegation facility Staff do not ensure adequate food portions are provided to residents. Based on observation and interviews the facility prepares each meal in bulk and keeps it warm in the kitchen on warming trays. The food is then dished up based on the resident’s order.

On the allegation facility Staff does not ensure facility is kept in good repair at all times. Based on record review and interviews the facility did have a plumbing problem with one of the hallway bathrooms. S1 has been working with the maintenance staff trying to fix this issue. S1 explained that the issue was much deeper in the plumbing and required city work to fix. The work was scheduled and completed.

On the allegation facility Staff do not ensure unsafe furniture is removed from the facility. Based on observation and interviews the facility has a table in the dining room with a glass top where the glass top exceeds several inches past the table. The facility has since removed the glass top.

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 Humpal	TELEPHONE: (510) 285-3928
LICENSING EVALUATOR NAME: Jill Clancy-Czuleger	TELEPHONE: 510-286-4201
LICENSING EVALUATOR SIGNATURE:	DATE: 05/14/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/14/2024

LIC9099 (FAS) - (06/04)

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