079201152-7-20-2023-15-AS-YFLS-CU2W2J-20230724165427

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 079201152
Report Date: 07/20/2023
Date Signed: 07/20/2023 05:15:58 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
03/08/2023 and conducted by Evaluator Lisha Holmes

PUBLIC

COMPLAINT CONTROL NUMBER: 15-AS-20230308145100

FACILITY NAME:	GREENRIDGE SENIOR LIVING		FACILITY NUMBER:	079201152
ADMINISTRATOR:	SINGH, RUBY		FACILITY TYPE:	740
ADDRESS:	2150 PYRAMID DRIVE		TELEPHONE:	(510) 758-9600
CITY:	RICHMOND	STATE: CA	ZIP CODE:	94803
CAPACITY:	38	CENSUS: 12	DATE:	07/20/2023
		UNANNOUNCED	TIME BEGAN:	04:35 PM
MET WITH:	Patrick Blanc, Administrator		TIME COMPLETED:	05:30 PM

ALLEGATION(S):

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Neglect

INVESTIGATION FINDINGS:

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On 07/20/23 at 04:35 PM, Licensing Program Analyst (LPA) L. Holmes arrived unannounced to deliver the finding for the above allegation. Upon arrival, LPA met with Patrick Blanc, Administrator (ADM) and explained the purpose of the visit.

Allegation: Neglect

During the course of the investigation, LPA obtained information, collected documents, reviewed records, interviewed staff, and witnesses. It was alleged that an unknown facility staff member(s) neglected Resident #1 (R1) by leaving R1 wet after showering. The date of the incident is unknown, and LPA did not receive a callback from the complainant during the investigation.
continued on LIC9099C...

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Yvonne Flores-Larios	TELEPHONE: (510) 286-0517
LICENSING EVALUATOR NAME: Lisha Holmes	TELEPHONE: 510-286-4201
LICENSING EVALUATOR SIGNATURE:	DATE: 07/20/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/20/2023

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-20230308145100

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: GREENRIDGE SENIOR LIVING	FACILITY NUMBER: 079201152
	VISIT DATE: 07/20/2023

NARRATIVE

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...continued from LIC9099.

The complainant also reported that R1 was physically dropped by a staff member(s) on 03/02/23.

Based on LPA’s record reviews and interviews with Staff (S1, S2 & S3), and Witnesses (W1 & W2), it was revealed that R1 could walk using assistance from a walker according to S2, and although R1 needed assistance getting dressed R1 would let S2 know if he/she didn’t want to change clothes, but maybe later and R1 would do that; R1 was alert and could ask to go to the hospital on his/her own. S1 stated that R1 could move around unassisted. S3 confirmed that R1 transferred from the Skilled Nursing Facility (SNF) at Greenridge Senior Living, El Sobrante, CA on 02/18/23. W1 stated, “R1 had a stroke about six years ago, made so many comebacks, beat COVID, and the facility really did a great job with R1.” W2 stated that the allegations are ridiculous and W1 did his/her very best taking care of R1. W1 stated that R1 died in the hospital 02/27/23 on his/her own after being in and out of the hospital for years.

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 and a copy of this report provided to Administrator.

SUPERVISOR'S NAME: Yvonne Flores-Larios	TELEPHONE: (510) 286-0517
LICENSING EVALUATOR NAME: Lisha Holmes	TELEPHONE: 510-286-4201
LICENSING EVALUATOR SIGNATURE:	DATE: 07/20/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/20/2023

LIC9099 (FAS) - (06/04)

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