<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 011400627
Report Date: 10/02/2024
Date Signed: 10/02/2024 03:45:20 PM

Substantiated


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
04/23/2024 and conducted by Evaluator Grace Luk
PUBLIC
COMPLAINT CONTROL NUMBER: 15-AS-20240423151822
FACILITY NAME:ST. PAUL'S TOWERSFACILITY NUMBER:
011400627
ADMINISTRATOR:YUEN, CONNIEFACILITY TYPE:
741
ADDRESS:100 BAY PLACETELEPHONE:
(510) 835-4700
CITY:OAKLANDSTATE: CAZIP CODE:
94610
CAPACITY:320CENSUS: 205DATE:
10/02/2024
UNANNOUNCEDTIME BEGAN:
01:50 PM
MET WITH:Connie Yuen, Executive Director
Angela Zamarripa, Director of Resident Health Services 		TIME COMPLETED:
04:00 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Staff did not check background of caregiver prior to caregiver providing care to residents.
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
On 10/2/2024 at 1:50PM, Licensing Program Analysts (LPAs) G. Luk and D. Doidge arrived unannounced to conduct a complaint investigation and deliver findings in regards to the allegation above. LPAs met with Executive Director, Connie Yuen and Director of Resident Health Services, Angela Zamarripa.

During the course of investigation, LPA G. Luk interviewed 2 staff, complainant, and witness. LPA reviewed and obtained staff roster, resident roster, physician's report, emergency contact information, admission agreement, and care plan.

Interview with staff and complainant revealed that a private caregiver was not fingerprint cleared prior to providing care to resident (R1). S3 stated that facility's Resident Services Manager would handle the on boarding process for private caregivers which includes fingerprint clearance and cannot be at the facility until clearance is complete. (Continue on LIC9099C...)
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Harpreet Humpal
LICENSING EVALUATOR NAME: Grace Luk
LICENSING EVALUATOR SIGNATURE:

DATE: 10/02/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/02/2024
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 3
Control Number 15-AS-20240423151822
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: ST. PAUL'S TOWERS
FACILITY NUMBER: 011400627
VISIT DATE: 10/02/2024
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
***This is an amended copy of report issued on 10/2/2024***
Based on LPA's information obtained during investigation, the preponderance of evidence standard has been met; therefore, the above allegation is found to be SUBSTANTIATED. Heath and Safety Code are being cited on the attached LIC9099D.

Civil penalty of $500 is being assessed.

Exit interview conducted with Connie Yuen. A copy of this report, civil penalty, and appeal rights provided.
SUPERVISORS NAME: Harpreet Humpal
LICENSING EVALUATOR NAME: Grace Luk
LICENSING EVALUATOR SIGNATURE:

DATE: 10/02/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/02/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 15-AS-20240423151822
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: ST. PAUL'S TOWERS
FACILITY NUMBER: 011400627
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/02/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
10/03/2024
Section Cited
HSC
1569.17
1
2
3
4
5
6
7
***This is an amended copy of report issued on 10/2/2024*** Fingerprints and criminal records...An individual shall be required to obtain either a criminal record clearance or a criminal record exemption from the State Department of Social Services... This requirement is not met as evidence by:
1
2
3
4
5
6
7
***This is an amended copy of report issued on 10/2/2024*** Executive Director has agreed to create a plan to address fingerprint clearance for private caregivers and submit the plan to CCLD by POC date.
8
9
10
11
12
13
14
Based on investigation, licensee did not comply with the section cited above by not having private caregiver fingerprint cleared which poses an immediate health and safety risk to the persons in care.
8
9
10
11
12
13
14
Civil penalty of $500 is being assessed.
1
2
3
4
5
6
7
1
2
3
4
5
6
7
1
2
3
4
5
6
7
1
2
3
4
5
6
7
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISORS NAME: Harpreet Humpal
LICENSING EVALUATOR NAME: Grace Luk
LICENSING EVALUATOR SIGNATURE:

DATE: 10/02/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/02/2024
LIC9099 (FAS) - (06/04)
Page: 3 of 3