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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 015600693
Report Date: 06/19/2025
Date Signed: 06/19/2025 01:45:39 PM

Unsubstantiated


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
06/12/2025 and conducted by Evaluator Kelly Nguyen
COMPLAINT CONTROL NUMBER: 15-AS-20250612114717
FACILITY NAME:PLEASANT HILL MANORFACILITY NUMBER:
015600693
ADMINISTRATOR:RICHARD W. GINDLESBERGERFACILITY TYPE:
740
ADDRESS:27794 PLEASANT HILL CTTELEPHONE:
(510) 581-3557
CITY:HAYWARDSTATE: CAZIP CODE:
94542
CAPACITY:6CENSUS: 5DATE:
06/19/2025
UNANNOUNCEDTIME BEGAN:
08:30 AM
MET WITH:Richard W. Gindlesberger, Administrator TIME COMPLETED:
12:00 PM
ALLEGATION(S):
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Staff prevented the long-term care ombudsman representatives from conducting a facility visit
INVESTIGATION FINDINGS:
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On 6/19/2025, at 8:30 am, Licensing Program Analyst (LPA), K. Nguyen, arrived unannounced to conduct interviews regarding the above allegation. LPA met with Administrator (ADM) Richard W. Gindlesberger and explained the purpose of the visit.

Allegation: Staff prevented the long-term care ombudsman representatives from conducting a facility visit

During the course of the investigation, LPA reviewed the residents' roster and conducted interviews with staff and residents.

Report Continued on LIC9099c...
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Bennett Fong
LICENSING EVALUATOR NAME: Kelly Nguyen
LICENSING EVALUATOR SIGNATURE:

DATE: 06/19/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/19/2025
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 2
Control Number 15-AS-20250612114717
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: PLEASANT HILL MANOR
FACILITY NUMBER: 015600693
VISIT DATE: 06/19/2025
NARRATIVE
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Based on interviews conducted, the Administrator denied the allegation “Staff prevented the long-term care ombudsman representatives from conducting a facility visit.” ADM stated that my staff 1 (S1) let the ombudsman 1 (O1) and Ombudsman 2 (O2) in when O1 and O2 asked. S1 stated, “O1 asked to come in and have a walk through the facility and looked at the residents' rooms. O1 and O2 also talked to all the residents. When O1 asked about medication, S1 stated that S1 needs to contact ADM to clarify. S1 didn’t understand what O1 was requesting regarding medication.

ADM later came alittle later and spoke with O1 at the facility. S1 stated ADM just wanted to clarify exactly what O1 needed with the medication. ADM explained to O1 that ADM needed to get clarification from licensing if O1 wanted to see medication files. However, O1 got upset and said, “I will contact licensing”. ADM tried to explain to O1 that ADM needed consent from residents before showing any medication that is being requested. O1 and O2 left.

On 6/19/2025, LPA interviewed 5 of 5 residents. Resident 1 (R1) states R1 spoke to the Ombudsman, but didn’t know that they were the Ombudsman. R1 stated, “They never introduce themselves, but handed R1 a business card. R1 stated, 'They asked if I was okay at the facility, and I answered I am ok". Resident 2 (R2) recalled talking to the Ombudsman, but didn’t know they were an Ombudsman. Resident 3 (R3) stated, “I spoke to them and asked if I had any complaints. I said no!”. Resident 4 (R4) talked to the Ombudsman, but didn’t know who they were. Resident 5 (R5) talked to the Ombudsman. R5 stated, “They asked if I like the facility and how’s the food, etc”. I told them that this is my home, and I have no complaint”.

LPA interviewed ADM. ADM confirmed with LPA that ADM Staff did not prevented the long-term care ombudsman representatives from conducting a facility visit

Based on interviews conducted, the above allegation is unsubstantiated.

Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur; therefore, the allegation is unsubstantiated.

There is no deficiency noted.

SUPERVISORS NAME: Bennett Fong
LICENSING EVALUATOR NAME: Kelly Nguyen
LICENSING EVALUATOR SIGNATURE:

DATE: 06/19/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/19/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 2