079201273-10-26-2023-15-AS-BFOG-CZXMEY-20240129083330

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 079201273
Report Date: 10/26/2023
Date Signed: 10/26/2023 02:01:16 PM

Unfounded

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
E BAY DELTA AC/SC, 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
10/19/2023 and conducted by Evaluator Lori Alexander-Washington

PUBLIC

COMPLAINT CONTROL NUMBER: 15-AS-20231019163144

FACILITY NAME:	HEATHERWOOD MEMORY CARE		FACILITY NUMBER:	079201273
ADMINISTRATOR:	GONZALES, RITCHIE		FACILITY TYPE:	740
ADDRESS:	1315 MT PISGAH ROAD		TELEPHONE:	(925) 939-2833
CITY:	WALNUT CREEK	STATE: CA	ZIP CODE:	94596
CAPACITY:	32	CENSUS: 25	DATE:	10/26/2023
		UNANNOUNCED	TIME BEGAN:	12:00 PM
MET WITH:	Ritchie Gonzales, Licensee/Administrator		TIME COMPLETED:	02:05 PM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Licensee is not maintaining liability insurance.

INVESTIGATION FINDINGS:

1
2
3
4
5
6
7
8
9
10
11
12
13

On this day at around 12:00PM Licensing Program Analyst (LPA) L. Alexander arrived unannounced to conduct 10-day investigation and met with Licensee/Administrator, Ritchie Gonzales. LPA explained to Licensee/Administrator the purpose of visit.

During the visit, LPA requested the following records: Certificate of Liability Insurance. LPA received Premium Finance Agreement and Certificate of Liability Insurance with Effective Date of Policy 08/01/2023.

Based on the information gathered during the course of investigation, the 1 allegation is closed as Unfounded. A finding that the complaint is Unfounded means that the allegation is false, could not have happened, and/or is without a reasonable basis.

No deficiencies cited. Exit Interview conducted and a copy of this report provided.

Unfounded

Estimated Days of Completion:

SUPERVISOR'S NAME: Bennett Fong	TELEPHONE: (510) 725-7919
LICENSING EVALUATOR NAME: Lori Alexander-Washington	TELEPHONE: (510) 285-3934
LICENSING EVALUATOR SIGNATURE:	DATE: 10/26/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/26/2023

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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