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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 019200848
Report Date: 11/15/2024
Date Signed: 11/15/2024 06:12:04 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
05/06/2024 and conducted by Evaluator Grace Luk
PUBLIC
COMPLAINT CONTROL NUMBER: 15-AS-20240506153219
FACILITY NAME:FREMONT RTRMT COM-HAPPY LVNG BY COGIR/COGIR FREMONFACILITY NUMBER:
019200848
ADMINISTRATOR:KABADI, SANJAY PFACILITY TYPE:
740
ADDRESS:2860 COUNTRY DRIVETELEPHONE:
(510) 790-1645
CITY:FREMONTSTATE: CAZIP CODE:
94536
CAPACITY:40CENSUS: 41DATE:
11/15/2024
UNANNOUNCEDTIME BEGAN:
02:30 PM
MET WITH:Michael Sharkey, Executive DirectorTIME COMPLETED:
05:00 PM
ALLEGATION(S):
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Staff do not answer residents' call buttons in a timely manner
Staff do not ensure that residents' dietary needs are being met
Staff speaks inappropriately while in the presence of residents
INVESTIGATION FINDINGS:
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On 11/15/2024 at 2:30PM, Licensing Program Analyst (LPA) G. Luk arrived unannounced to conduct investigation and deliver complaint findings for the allegations above. LPA met with Executive Director, Michael Sharkey and explained the purpose the visit.

During the investigation, LPA interviewed 5 residents, 4 staff, and witness. LPA reviewed and obtained documents including call button log and staff schedule.

Staff do not answer residents' call buttons in a timely manner
Interview with staff indicated that call button response time is less than 10 minutes. After reviewing the call button log, AL (Assisted Living) response time average is 10-15 minutes. Interview with residents revealed that staff usually respond to call button in 5-10 minutes.
(Continue on LIC9099C...)
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Harpreet Humpal
LICENSING EVALUATOR NAME: Grace Luk
LICENSING EVALUATOR SIGNATURE:

DATE: 11/15/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/15/2024
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 2
Control Number 15-AS-20240506153219
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: FREMONT RTRMT COM-HAPPY LVNG BY COGIR/COGIR FREMON
FACILITY NUMBER: 019200848
VISIT DATE: 11/15/2024
NARRATIVE
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Staff do not ensure that residents' dietary needs are being met
Interview with residents revealed that residents did not have issues receiving their meals. Interview with staff indicated that resident's dietary needs are given to kitchen staff and prepared accordingly. Staff have not witness resident's dietary needs not being met.

Staff speaks inappropriately while in the presence of residents
Interview with residents revealed that staff are nice and friendly. Interview with staff indicated they have not witness a staff spoken inappropriately or used profanity in the presence of residents.

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

Exit interview conducted. A copy of this report provided.
SUPERVISORS NAME: Harpreet Humpal
LICENSING EVALUATOR NAME: Grace Luk
LICENSING EVALUATOR SIGNATURE:

DATE: 11/15/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/15/2024
LIC9099 (FAS) - (06/04)
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