079200855-2-17-2023-15-AS-KHOS-CPPM97-20230307082415

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 079200855
Report Date: 02/17/2023
Date Signed: 02/17/2023 04:19:14 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
08/10/2021 and conducted by Evaluator Alicia Delmundo

COMPLAINT CONTROL NUMBER: 15-AS-20210810103558

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: 89	DATE:	02/17/2023
		UNANNOUNCED	TIME BEGAN:	12:25 PM
MET WITH:	Shiobhan Lehman/Executive Director		TIME COMPLETED:	04:20 PM

ALLEGATION(S):

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-Facility failed to open the resident rooms immediately in the event of emergency.

-Food serve not of good quality..

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Alicia Delmundo arrived unannounced to continue the investigation of the above allegations, and close the complaint. LPA met with Shiobhan Lehman, and informed the purpose of visit.

During the course of investigation, LPA obtained copies of resident rosters, staff schedule and menus.

On 8/18/21, LPAJill Clancy-Czuleger inspected the dining rooms in assisted living and memory care units and kitchen. LPA A, Delmundo conducted interviews on 8/18/21 and 2/17/23, and inpected the food supplies, and checked the menus for the month and weekly menus on 2/17/23. LPA randomly selected 5 residents rooms and asked the ED to open the rooms with the master key.

....continued on 9099C

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Bennett Fong	TELEPHONE: (510) 622-2621
LICENSING EVALUATOR NAME: Alicia Delmundo	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-20210810103558

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: 02/17/2023

NARRATIVE

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Allegation: Facility failed to open the resident rooms immediately in the event of emergency.
It was alleged that there were several incidents when staff were not able to open the resident rooms immediately when residents had emergency. It was further alleged there's bunch of keys with no labels making it difficult for the staff to find the right key to open the resident's roomm and that there should be a master key for all rooms.

One of out residents interviewed stated there were incidents when staff were not able to open the resident's room when resident had an emergency. The other 4 residents stated there was no incident staff not able to open the room when help is needed. One out of 5 staff stated there were 2 master keys before, one for the 1st floor and one for the second floor, and these master keys do not work on 2 rooms on the second but there's extra key for these 2 rooms. The other 4 staff interviewed stated there's master key for all residents' rooms, and that there were no incident that it didn't work.. During randomly checking of the rooms, LPA observed the master key worked on 5 rooms. LPA further observed the duplicate keys were labeled with residents rooms, and there's a master key for use by care staff and med-techs.

Allegation: Food serve not of good quality..
It was alleged that frequently, vegetables are served almost raw.

LPA conducted inspection of food supplies and observed of good quality.

One out of 5 residents interviewed stated vegetables served almost raw. Two out of 5 residents stated the food is okay and never served raw vegetables while 1 resident stated sometimes vegetables are overcooked.
One out of 5 staff stated sometimes the food serve is good, sometimes it's not but never served raw. One of the staff stated some residents say food is good and some will say it's not but you can not please everyone but this staff never heard any complaint from any of the resident about raw food. The other 3 staff stated never heard complaint about food from residents.

Based on all information obtained, the allegations are closed as unsubstantiated. A finding that a complaint is unsubstantiated means that although the allegations may have happened or are valid, there is not a preponderance of the evidence to prove that the alleged violation occurred.

No citation issued. Exit interview conducted and copy of this report provided.

SUPERVISOR'S NAME: Bennett Fong	TELEPHONE: (510) 622-2621
LICENSING EVALUATOR NAME: Alicia Delmundo	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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