079200995-3-8-2024-15-AS-KHOS-D45RNS-20240408131050

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 079200995
Report Date: 03/08/2024
Date Signed: 03/08/2024 02:29:25 PM

Substantiated

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
03/06/2024 and conducted by Evaluator Daisy Panlilio

COMPLAINT CONTROL NUMBER: 15-AS-20240306134630

FACILITY NAME:	CAREFRONT RESIDENTIAL LIVING, LLC		FACILITY NUMBER:	079200995
ADMINISTRATOR:	WANG, DING		FACILITY TYPE:	740
ADDRESS:	4086 TULARE DR		TELEPHONE:	(925) 890-8953
CITY:	CONCORD	STATE: CA	ZIP CODE:	94521
CAPACITY:	6	CENSUS: 6	DATE:	03/08/2024
		UNANNOUNCED	TIME BEGAN:	01:34 PM
MET WITH:			TIME COMPLETED:	03:30 PM

ALLEGATION(S):

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Facility has a lock on the front door to prevent the residents from leaving the facility

INVESTIGATION FINDINGS:

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On 03/08/24 at 1:34PM, Licensing Program Analyst (LPA) D Panlilio conducted an unannounced complaint visit, met with administrator (ADM), gathered information and delivered investigation finding of above allegation. LPA explained the purpose of the visit with ADM.

During investigation, LPA interviewed staff (S1, S2) and observed additional inside front door lock. LPA obtained the following documents from administrator: Personnel record and Resident roster. LPA observed an additional inside lock located on the upper right hand corner of the front door during visit.

Continued on next page, LIC 9099-C

Substantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Bennett Fong	TELEPHONE: (510) 622-2621
LICENSING EVALUATOR NAME: Daisy Panlilio	TELEPHONE: (510) 286-4201
LICENSING EVALUATOR SIGNATURE:	DATE: 03/08/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/08/2024

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-20240306134630

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: CAREFRONT RESIDENTIAL LIVING, LLC	FACILITY NUMBER: 079200995
	VISIT DATE: 03/08/2024

NARRATIVE

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Allegation: Facility has a lock on the front door to prevent the residents from leaving the facility
Investigation Finding: Substantiated
During investigation, LPA interviewed staff (S1, S2) who stated that the front door lock was necessary to prevent residents with dementia from leaving the facility without the knowledge of staff. Witness (W1) also observed the front door lock at the facility during a site visit on 03/04/24 and confirmed with staff (S1, S2) that the front door lock was placed to keep exit seeking residents from leaving the facility. ADM instructed staff (S1) to remove the additional front door inside lock. LPA witnessed staff remove the additional front door lock during visit.

Based on the department’s observations and interviews which were conducted and record review(s), the preponderance of evidence standard has been met, therefore the allegation(s) that facility has a lock on the front door to prevent the residents from leaving the facility was found to be substantiated.

Deficiency is cited per Title 22 California Code of Regulations and listed on LIC9099D. Failure to submit proof of corrections (POC) by plan of correction due dates and/or any repeat deficiencies within a 12-month period may result in civil penalties.

Exit interview conducted, appeal rights and copy of report provided.

SUPERVISOR'S NAME: Bennett Fong	TELEPHONE: (510) 622-2621
LICENSING EVALUATOR NAME: Daisy Panlilio	TELEPHONE: (510) 286-4201
LICENSING EVALUATOR SIGNATURE:	DATE: 03/08/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/08/2024

LIC9099 (FAS) - (06/04)

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Control Number 15-AS-20240306134630

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: CAREFRONT RESIDENTIAL LIVING, LLC	FACILITY NUMBER: 079200995
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 03/08/2024

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 03/08/2024 Section Cited CCR 87468.1(a)(6)	1 2 3 4 5 6 7	Residents in all residential care facilities for the elderly shall have all of the following personal rights: To leave or depart the facility at any time and to not be locked into any room, building, or on facility premises by day or night.	1 2 3 4 5 6 7	On 03/07/24 at 1:45PM, LPA observed staff (S2) remove the additional inside front door lock during visit. Deficiency cleared during visit.
	8 9 10 11 12 13 14	This requirement was not met as evidenced by the facility having an additional inside front door lock to prevent residents from leaving the facility which is in violation of Title 22 Section 87468.1 1 Personal Rights of Residents in all Facilities.	8 9 10 11 12 13 14
	1 2 3 4 5 6 7		1 2 3 4 5 6 7
	1 2 3 4 5 6 7		1 2 3 4 5 6 7

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

SUPERVISOR'S NAME: Bennett Fong	TELEPHONE: (510) 622-2621
LICENSING EVALUATOR NAME: Daisy Panlilio	TELEPHONE: (510) 286-4201
LICENSING EVALUATOR SIGNATURE:	DATE: 03/08/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/08/2024

LIC9099 (FAS) - (06/04)

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