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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 019200521
Report Date: 07/21/2022
Date Signed: 07/21/2022 12:20:23 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
07/19/2022 and conducted by Evaluator Kelly Nguyen
COMPLAINT CONTROL NUMBER: 15-AS-20220719161226
FACILITY NAME:CREEKVIEW ASSISTED LIVINGFACILITY NUMBER:
019200521
ADMINISTRATOR:PATRICK D. MCELROYFACILITY TYPE:
740
ADDRESS:2900 STONERIDGE DRIVETELEPHONE:
(925) 353-5717
CITY:PLEASANTONSTATE: CAZIP CODE:
94588
CAPACITY:136CENSUS: 69DATE:
07/21/2022
UNANNOUNCEDTIME BEGAN:
09:55 AM
MET WITH:Patrick Mcelroy, AdminstratorTIME COMPLETED:
12:25 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Facility air conditioning unit is in disrepair.
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
On 7/21/2022 at 9:45AM Licensing Program Analyst (LPA) K. Nguyen, arrived unannounced to conduct investigation on the above allegations. LPA met with Assisted Living Administrator, Patrick Mcelroy, and explained the purpose of the visit.
It was alleged that facility air conditioning unit is in disrepair. During the course of investigation, LPA reviewed invoices, communication log, and visitation log to determine the timeline of facility responsiveness to the alligation. LPA tour the facility, sample four room in AL and MC. LPA interview two resident and attempted to interview two other residents, and interview 6 staffs. It was found that the facility air conditioning unit is in disrepair, however the facility being responsive to resident’s needs and their accomidation. The facility is in the process of getting the air condition repair.
Unsubstantiated:
although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation(s) did or did not occur, therefore the allegation is UNSUBSTANTIATED.
Exit interview conducted and a copy of the report of given to the Administrator.

Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Bennett Fong
LICENSING EVALUATOR NAME: Kelly Nguyen
LICENSING EVALUATOR SIGNATURE:

DATE: 07/21/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/21/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
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