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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 079201440
Report Date: 07/22/2025
Date Signed: 07/22/2025 04:28:15 PM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
OAKLAND ASC, 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
04/21/2025 and conducted by Evaluator Tonica Syess-Gibson
PUBLIC
COMPLAINT CONTROL NUMBER: 15-AS-20250421120751
FACILITY NAME:JOY SENIOR CENTERFACILITY NUMBER:
079201440
ADMINISTRATOR:MATHARU, GURPREETFACILITY TYPE:
740
ADDRESS:6400 BRENTWOOD BLVDTELEPHONE:
(510) 543-4695
CITY:BRENTWOODSTATE: CAZIP CODE:
94513
CAPACITY:18CENSUS: 13DATE:
07/22/2025
UNANNOUNCEDTIME BEGAN:
10:40 AM
MET WITH:Sakaraia Kata, Direct Care Staff TIME COMPLETED:
04:38 PM
ALLEGATION(S):
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Staff did not ensure that resident in care was turned as needed.
Resident developed a pressure injury while in care due to staff neglect.
INVESTIGATION FINDINGS:
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On 07/22/205, at 10:40am, Licensing Program Analyst (LPA) T. Syess-Gibson arrived unannounced to conduct a complaint investigation and to deliver complaint findings for the allegations above. LPA met with Sakaraia Kata, Direct Care Staff and explained the purpose of the visit.

During the course of the investigation, LPA obtained the following documents: (employees’ roster and residents’ roster, physician reports, appraisal needs and services plan, repositioning log, after visit hospital summary report, incident reports LIC624, home health care notes, and residents’ identification and emergency information for R1. On 07/22/2025, LPA interviewed staff, Home Health and obtained the following documents: vitals record, training (wound care) log, home health care notes from 03/28-05/16/2025, and hospice care notes from 05/21/2025-07/14/2025.

Continue on LIC9099C)
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Harpreet Humpal
LICENSING EVALUATOR NAME: Tonica Syess-Gibson
LICENSING EVALUATOR SIGNATURE:

DATE: 07/22/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/22/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 1 of 3
Control Number 15-AS-20250421120751
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
OAKLAND ASC, 1515 CLAY STREET, STE. 310
OAKLAND, CA 94612
FACILITY NAME: JOY SENIOR CENTER
FACILITY NUMBER: 079201440
VISIT DATE: 07/22/2025
NARRATIVE
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Continued from LIC9099

Interview with W1 indicated that R1’s pressure injuries developed from prolonged supine immobility prior to hospital admission. Incident report dated 04/23/2025 revealed that the facility reported R1 had two wounds when R1 returned from hospital on 04/20/2025. Interviews with S1, S2 and Home Health indicate consistent statements of staff being attentive to the residents’ care needs and staff did not neglect to provide care. Interview with Home Health and Home Health notes revealed staff were trained by home health to provide care R1 and that R1 was receiving home health care from 3/28/2025 to 05/16/2025.

Allegations:

Staff did not ensure that resident in care was turned as needed.



Interviews with staff, Home Health and record review revealed that R1 was repositioned every 2 hours. R1's home health notes indicated that R1 was receiving ongoing monitoring and education to help prevent exacerbation of conditions and reduce the risk of hospitalization.


Resident developed a pressure injury while in care due to staff neglect.

Interviews with staff, Home Health and records review revealed that R1 did not develop pressure injury while in care and staff did not neglect to provide care. R1 was receiving home health services from 03/28/2025-05/16/2025.

Continue on LIC9099C

SUPERVISORS NAME: Harpreet Humpal
LICENSING EVALUATOR NAME: Tonica Syess-Gibson
LICENSING EVALUATOR SIGNATURE:

DATE: 07/22/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/22/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 15-AS-20250421120751
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
OAKLAND ASC, 1515 CLAY STREET, STE. 310
OAKLAND, CA 94612
FACILITY NAME: JOY SENIOR CENTER
FACILITY NUMBER: 079201440
VISIT DATE: 07/22/2025
NARRATIVE
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Continued from LIC9099C



Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did occur, therefore these allegations are UNSUBSTANTIATED.


No deficiencies are being cited on this date.


Exit interview conducted with Sakaraia Kata. A copy of this report provided.
SUPERVISORS NAME: Harpreet Humpal
LICENSING EVALUATOR NAME: Tonica Syess-Gibson
LICENSING EVALUATOR SIGNATURE:

DATE: 07/22/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/22/2025
LIC9099 (FAS) - (06/04)
Page: 3 of 3