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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 019200973
Report Date: 12/06/2024
Date Signed: 12/06/2024 05:14:32 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
09/01/2023 and conducted by Evaluator Grace Luk
PUBLIC
COMPLAINT CONTROL NUMBER: 15-AS-20230901100347
FACILITY NAME:BETHANY HOME SENIOR LIVING, LLCFACILITY NUMBER:
019200973
ADMINISTRATOR:NAGY, ARPADFACILITY TYPE:
740
ADDRESS:3322 EAST AVE.TELEPHONE:
(925) 443-6822
CITY:LIVERMORESTATE: CAZIP CODE:
94550
CAPACITY:58CENSUS: 30DATE:
12/06/2024
UNANNOUNCEDTIME BEGAN:
02:15 PM
MET WITH:Rachell Paniagua, Manager
Chearamy Evangelista, Caregiver		TIME COMPLETED:
05:25 PM
ALLEGATION(S):
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Staff left resident soiled for a period of time.
Staff does not allow resident to use the phone.
Staff does not allow resident to have visitors.
Staff does not accord resident privacy during visitations.
INVESTIGATION FINDINGS:
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On 12/6/2024 at 2:15PM, Licensing Program Analyst (LPA) G. Luk arrived unannounced to conduct complaint investigation and deliver findings in regards to the allegations above. LPA met with Manager, Rachell Paniagua.

During the course of investigation, LPA interviewed 3 residents, 3 staff, witness, and complainant. LPA obtained and reviewed documents including physician's report, emergency information, and facility notes.

Staff left resident soiled for a period of time.
Interview with witness revealed that R1 was not left in soiled diaper for a period of time. W1 stated there was no issues with R1's toileting needs and was pleased with the care R1 was receiving. Interview with staff indicated that residents are changed 2-3 times per shift or checked for incontinence care every 2-3 hours.
(Continue on LIC9099C...)
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Harpreet Humpal
LICENSING EVALUATOR NAME: Grace Luk
LICENSING EVALUATOR SIGNATURE:

DATE: 12/06/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/06/2024
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-20230901100347
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: BETHANY HOME SENIOR LIVING, LLC
FACILITY NUMBER: 019200973
VISIT DATE: 12/06/2024
NARRATIVE
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Staff does not allow resident to use the phone.
Interview with residents and witness revealed that residents are able to use the phone when needed. Interview with staff indicated that some residents have their own phones and can use the facility phone when needed.

Staff does not allow resident to have visitors.
Interview with residents and witness revealed that residents are able to have visitors at the facility. W1 stated she has visited R1 a few times at the facility and others are able to visit R1 too. Interview with staff indicated that visiting hours are from 9AM to 6PM and residents are able to have visitors.

Staff does not accord resident privacy during visitations.
Interview with residents and witness revealed that residents are able to have privacy during visitations. Interview with staff indicated that residents can have privacy in their own rooms during visitation or phone calls. S3 stated that R1's phone calls and visitations are not monitored by staff.

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 with Chearamy Evangelista. A copy of this report provided.
SUPERVISORS NAME: Harpreet Humpal
LICENSING EVALUATOR NAME: Grace Luk
LICENSING EVALUATOR SIGNATURE:

DATE: 12/06/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/06/2024
LIC9099 (FAS) - (06/04)
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