079200962-5-19-2023-15-AS-YFLS-CSKTLC-20230607144919

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 079200962
Report Date: 05/19/2023
Date Signed: 05/19/2023 03:09:45 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
05/16/2023 and conducted by Evaluator Gregory Clark

PUBLIC

COMPLAINT CONTROL NUMBER: 15-AS-20230516123108

FACILITY NAME:	WATERMARK AT SAN RAMON, THE		FACILITY NUMBER:	079200962
ADMINISTRATOR:	HARRISON, NANCY		FACILITY TYPE:	740
ADDRESS:	12720 ALCOSTA BLVD		TELEPHONE:	(925) 725-1485
CITY:	SAN RAMON	STATE: CA	ZIP CODE:	94583
CAPACITY:	95	CENSUS: 53	DATE:	05/19/2023
		UNANNOUNCED	TIME BEGAN:	01:35 PM
MET WITH:	Keil Stromgren, Executive Director		TIME COMPLETED:	03:15 PM

ALLEGATION(S):

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Staff are not providing key fobs for access to the facility
Staff are retaliating against an authorized representative

INVESTIGATION FINDINGS:

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On 5/19/23 at 1:35 p.m., Licensing Program Analyst (LPA) Greg Clark arrived unannounced to conduct an initial 10-day complaint investigation and deliver findings in regard to the allegations above. LPA met with Keil Stromgren, Executive Director and explained the purpose of the visit.

During the course of investigation, LPA interviewed the Executive Director, 2 memory care staff (S1 and S2), reviewed memory care residents’ roster and staff roster and toured the memory care units. LPA observed that a key fob was needed to enter the memory care units on both the first and second floors. Staff reported that only staff have key fobs to enter the memory care unit. Staff also reported that families wanting to visit "after hours" are instructed to call the front desk so memory care staff can let them into the memory care unit. LPA found no evidence that staff were retaliating against any authorized representatives.

***report continues on LIC9099C***

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Yvonne Flores-Larios	TELEPHONE: (510) 286-0517
LICENSING EVALUATOR NAME: Gregory Clark	TELEPHONE: 510-285-3927
LICENSING EVALUATOR SIGNATURE:	DATE: 05/19/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/19/2023

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-20230516123108

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: WATERMARK AT SAN RAMON, THE	FACILITY NUMBER: 079200962
	VISIT DATE: 05/19/2023

NARRATIVE

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***report continues from LIC9099***

This agency has investigated the complaint that staff are not providing key fobs for access to the facility and staff are retaliating against an authorized representative . We have found that the complaint was unsubstantiated. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is UNSUBSTANTIATED.

Exit interview conducted, a copy of this report provided.

SUPERVISOR'S NAME: Yvonne Flores-Larios	TELEPHONE: (510) 286-0517
LICENSING EVALUATOR NAME: Gregory Clark	TELEPHONE: 510-285-3927
LICENSING EVALUATOR SIGNATURE:	DATE: 05/19/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/19/2023

LIC9099 (FAS) - (06/04)

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