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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 075600352
Report Date: 12/05/2024
Date Signed: 12/05/2024 02:37:28 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
07/11/2024 and conducted by Evaluator James Sampair
PUBLIC
COMPLAINT CONTROL NUMBER: 15-AS-20240711091855
FACILITY NAME:ATRIA WALNUT CREEKFACILITY NUMBER:
075600352
ADMINISTRATOR:KELLI GREENEFACILITY TYPE:
740
ADDRESS:1400 MONTEGOTELEPHONE:
(925) 938-6611
CITY:WALNUT CREEKSTATE: CAZIP CODE:
94598
CAPACITY:200CENSUS: 150DATE:
12/05/2024
UNANNOUNCEDTIME BEGAN:
01:30 PM
MET WITH:Executive Director Kelli GreeneTIME COMPLETED:
03:00 PM
ALLEGATION(S):
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Due to lack of supervision, resident eloped from the facility resulting in dealth from the heat.
INVESTIGATION FINDINGS:
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On 12/05/2024 at 1:30 PM, Licensing Program Analysts (LPA) James Sampair and David Doidge arrived unannounced to deliver findings on the allegations above. The LPAs informed Executive Director Kelli Greene of the reason for the visit.

The complaint alleges that due to lack of supervision, Resident R1 eloped from the facility resulting in death from the heat.

The Department's investigation included, but was not limited to, interviews with staff and residents. The Department obtained and reviewed records pertaining to Resident R1, which included facility records, staff records, medical records, Walnut Creek Police Department (WCPD) records, Contra Costa County Fire Protection District Emergency Medical Services (EMS) records, and R1’s death certificate.
Video footage from the facility shows R1 leaving the facility on their own. WCPD records show that after an extensive search R1 was found dead due to a cardiac arrest off the facility grounds.

Continued on LIC 9099-C . . .
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Harpreet Humpal
LICENSING EVALUATOR NAME: James Sampair
LICENSING EVALUATOR SIGNATURE:

DATE: 12/05/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/05/2024
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 2
Control Number 15-AS-20240711091855
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: ATRIA WALNUT CREEK
FACILITY NUMBER: 075600352
VISIT DATE: 12/05/2024
NARRATIVE
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. . . Continued from LIC 9099-A
Facility records show that R1 required assistance with mobility, showering, and transferring in and out of bed. R1’s level of care was listed as Level 1. R1 was otherwise independent with no diagnosis of dementia. Staff reported that R1 was independent and often declined assistance with showering and other tasks. Due to R1’s level of independence, R1’s care plan did not include routine status checks.

Staff interviews and facility records did not suggest a change in condition for R1. Care staff and management reported that they undergo elopement training once a month.

Residents were interviewed and had no concern about the care provided by staff. Staffing records show that five care staff were on duty, a number consistent with the facility’s standard staffing level.

Although the allegations may have happened, or are valid, there is not a preponderance of evidence to prove them; therefore, the allegation is UNSUBSTANTIATED.

Exit interview conducted and a copy of this report was provided.
SUPERVISORS NAME: Harpreet Humpal
LICENSING EVALUATOR NAME: James Sampair
LICENSING EVALUATOR SIGNATURE:

DATE: 12/05/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/05/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 2