075600353-12-30-2021-15-AS-KHOS-CAENX6-20220106095037

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 075600353
Report Date: 12/30/2021
Date Signed: 12/30/2021 09:37:34 AM

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
03/20/2020 and conducted by Evaluator Grace Luk

COMPLAINT CONTROL NUMBER: 15-AS-20200320104605

FACILITY NAME:	ATRIA VALLEY VIEW		FACILITY NUMBER:	075600353
ADMINISTRATOR:	JILL LIBHART		FACILITY TYPE:	740
ADDRESS:	1228 ROSSMOOR PKWY		TELEPHONE:	(925) 937-7300
CITY:	WALNUT CREEK	STATE: CA	ZIP CODE:	94595
CAPACITY:	153	CENSUS: 103	DATE:	12/30/2021
		UNANNOUNCED	TIME BEGAN:	08:40 AM
MET WITH:	Kelli Greene, Executive Director		TIME COMPLETED:	09:52 AM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Resident's are confined to their room.
Adequate food service is not being provided to residents.

INVESTIGATION FINDINGS:

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

On 12/30/2021 at 8:40AM, Licensing Program Analyst (LPA) G. Luk arrived unannounced to deliver complaint findings for the allegations above. LPA met with Executive Director, Kelli Greene.

During the investigation, LPA interviewed 4 residents, 6 staff, witness, and complainant. LPA obtained and reviewed resident roster, staff roster, facility menu, and communications sent to residents regarding COVID-19 procedures.

On 3/5/2020, CCLD sent out PIN 20-04-ASC to licensee regarding guidance on COVID-19. The PIN's guidance was to minimize congregate living activities and ensure that residents are eating their meals in their rooms instead of in congregate settings. The facility sent out communication to residents and families in March 2020 which stated "we strongly encourage residents to stay in their apartments, only leave when necessary and practice social distancing when outside of their apartment."
(Continue on LIC9099C...)

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Harpreet Humpal	TELEPHONE: (510) 285-3928
LICENSING EVALUATOR NAME: Grace Luk	TELEPHONE: (510) 286-4201
LICENSING EVALUATOR SIGNATURE:	DATE: 12/30/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/30/2021

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-20200320104605

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: ATRIA VALLEY VIEW	FACILITY NUMBER: 075600353
	VISIT DATE: 12/30/2021

NARRATIVE

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32

On 3/27/2020, LPA conducted a video tour of the facility and observed notices posted reminding residents to stay in their apartments. Interview with residents revealed that residents understood why they had to stay in their apartments during the pandemic. Residents stated that they can leave the apartment if needed.

Interview with residents revealed that food service was fine during the beginning of the pandemic (March 2020). Residents did not have issues receiving their meals during the pandemic. Residents have microwaves in their apartment to warm the meals if needed. Interview with staff revealed that meals were kept in a large bag to keep the food hot during delivery.

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

Exit interview conducted. A copy of this report provided.

SUPERVISOR'S NAME: Harpreet Humpal	TELEPHONE: (510) 285-3928
LICENSING EVALUATOR NAME: Grace Luk	TELEPHONE: (510) 286-4201
LICENSING EVALUATOR SIGNATURE:	DATE: 12/30/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/30/2021

LIC9099 (FAS) - (06/04)

Page: 2 of 2