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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 075600352
Report Date: 11/20/2023
Date Signed: 11/20/2023 05:33:14 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
11/16/2023 and conducted by Evaluator James Sampair
COMPLAINT CONTROL NUMBER: 15-AS-20231116112221
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: 135DATE:
11/20/2023
UNANNOUNCEDTIME BEGAN:
01:15 PM
MET WITH:Executive Director Kelli GreeneTIME COMPLETED:
05:45 PM
ALLEGATION(S):
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Staff changed the residents service plan without the consent of the residents authorized person
Resident was billed for services not rendered
INVESTIGATION FINDINGS:
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On 11/20/2023 at 1:15 PM, Licensing Program Analyst (LPA) J. Sampair performed an unannounced follow-up visit pertaining to the above allegations. Upon arrival, LPA stated the purpose of the visit to Executive Director (ED) Kelli Greene.

The complaint alleges that staff changed the resident's service plan without the consent of resident's authorized person. On 11/20/2023 at 10:29 AM, the LPA spoke with the Reporting Party (RP) who identified themself as the responsible person for Resident 1 (R1). Documentation reviewed by LPA confirmed that facility was acting in the best interest of R1.

CONTINUED ON LIC9099-C...
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Bennett Fong
LICENSING EVALUATOR NAME: James Sampair
LICENSING EVALUATOR SIGNATURE:

DATE: 11/20/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/20/2023
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-20231116112221
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: 11/20/2023
NARRATIVE
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...CONTINUED FROM LIC9099

The complaint alleges that resident was billed for services not rendered. The LPA reviewed the "Resident Monthly Assignment Report" for October 2023, verifying that the services for R1 for which the RP had been billed were provided.

Although the allegation may have happened, or is valid, there is not a preponderance of evidence to prove that staff did not notify residents of renovations made to the facility in a timely manner nor that staff did not follow a resident's medical needs while in care. Therefore, the allegations are UNSUBSTANTIATED.

Exit interview conducted with the ED and a copy of this report was provided via email.
SUPERVISORS NAME: Bennett Fong
LICENSING EVALUATOR NAME: James Sampair
LICENSING EVALUATOR SIGNATURE:

DATE: 11/20/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/20/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 2