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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 079200855
Report Date: 05/14/2024
Date Signed: 05/14/2024 01:07:49 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
01/24/2024 and conducted by Evaluator Jill Clancy-Czuleger
COMPLAINT CONTROL NUMBER: 15-AS-20240124165423
FACILITY NAME:TREVISTA CONCORDFACILITY NUMBER:
079200855
ADMINISTRATOR:THAMES, LORIFACILITY TYPE:
740
ADDRESS:1081 MOHR LNTELEPHONE:
(925) 798-3900
CITY:CONCORDSTATE: CAZIP CODE:
94518
CAPACITY:160CENSUS: 96DATE:
05/14/2024
UNANNOUNCEDTIME BEGAN:
11:00 AM
MET WITH:Siobhan Lehman,Executive Director TIME COMPLETED:
01:30 PM
ALLEGATION(S):
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Facility staff did not give a resident notice of change in level of care.
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 did not give a resident notice of change in level of care. Based on record review and interviews the facility did notify all residents that they were changing the point scale relating to each resident’s care plans. On February 2, 2023, the facility sent out a notice to all residents stating, “Our level of care points and charges are driven by two things - the time needed to complete a care task along with the level of expertise (of the staff member) needed to perform that task.” This notice stated that the increase would be effective April 1, 2023. This point system broken down all the points into eight different levels of care.

Continued on 9099C...
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Harpreet HumpalTELEPHONE: (510) 285-3928
LICENSING EVALUATOR NAME: Jill Clancy-CzulegerTELEPHONE: 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)
Page: 1 of 2
Control Number 15-AS-20240124165423
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 May 1, 2023, The facility sent out a second letter giving additional details to the point system and gave the residents an updated timeline of when the increase would be implemented as it was not ready at the previously stated April 1st date. This new notice provided the resident with a table of the point value of each service that is provided.

The new notice stated that the changes would be effective July 1, 2023, but in interviews with S1 she explained that each resident would start on the new point system when they had their yearly evaluation, and anyone who had their evaluation prior to July 1, would not be on the new point system until next year.

S1 stated that residents had expressed their concern with the new system and the number of levels, and the facility updated it once again on February 1, 2024 to reduce the number of levels from eight to four.

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 HumpalTELEPHONE: (510) 285-3928
LICENSING EVALUATOR NAME: Jill Clancy-CzulegerTELEPHONE: 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)
Page: 2 of 2