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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 019201143
Report Date: 01/02/2025
Date Signed: 02/05/2025 04:53:20 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
12/23/2024 and conducted by Evaluator Lisha Holmes
PUBLIC
COMPLAINT CONTROL NUMBER: 15-AS-20241223091751
FACILITY NAME:ELEGANCE BERKELEYFACILITY NUMBER:
019201143
ADMINISTRATOR:COE, ROBERTFACILITY TYPE:
740
ADDRESS:2100 SAN PABLO AVENUETELEPHONE:
(510) 788-1333
CITY:BERKELEYSTATE: CAZIP CODE:
94710
CAPACITY:120CENSUS: 47DATE:
01/02/2025
UNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Claudia Redditt, Director of Business AdministrationTIME COMPLETED:
12:04 PM
ALLEGATION(S):
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Staff did not prevent resident from harassing another resident.
INVESTIGATION FINDINGS:
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On 02/05/2025 around 01:35 PM, LPA amended complaints 15-AS-20241223152240 and 15-AS-20241223091751 to update the continuation pages. Executive Director (ED), Annemarie Domizio suggested that Licensing Program Analyst (LPA) L. Holmes meet with Claudia Redditt, Director of Business Administration (S1) due to ED's time constraints.
On 01/02/2024 around 09:45 AM, Licensing Program Analyst (LPA) L. Holmes arrived unannounced to conduct a 10-day investigation for the above allegation. LPA met with Douglas Blake, Interim Executive Director (ED) and explained the purpose for the visit.

Allegation: Staff did not prevent resident from harassing another resident.
UNSUBSTANTIATED.
During the course of the investigation and visit, LPA conducted interviews with Resident #1 (R1), Staff (S1, S2, S3, S4, S5) and Witness #1 (W1). LPA reviewed the facility's Face Sheet and Physician's Report (LIC602) for R1 & R2, and requested an updated staff and resident roster.

Report continued on LIC9099C...
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Yvonne Flores-Larios
LICENSING EVALUATOR NAME: Lisha Holmes
LICENSING EVALUATOR SIGNATURE:

DATE: 02/05/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/05/2025
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-20241223091751
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: ELEGANCE BERKELEY
FACILITY NUMBER: 019201143
VISIT DATE: 01/02/2025
NARRATIVE
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... amendment continued from LIC9099.

For the above allegation, R1 stated that R2 was verbally harassing him/her multiple times and just prior to the complaint is when R2 used a curse word towards R1. R1 could not identify any witnesses, R1 stated that the incident was reported to S1 and S2. S1 stated that R1 did not report that specific incident and S1 would have recalled something like that; R2 does have occasional outburst which may be due to a medical condition, but never anything abusive. S1 stated that he/she spoke to R1 regarding R2 allegedly glaring at R1. S1 suggested R1 and R2 sitting away from each other and/or repositioning R1's chair for avoidance. R1 requested LPA to allow him/her to remain anonymous with R2; therefore, LPA did not interview R2. S2 stated that there had been discussions on 01/02/24 about R1 and other residents having disagreements, and R1's disruptive behavior; R1 never reported the specific incident nor had S2 seen any verbal harassment. S3 did not remember ANYTHING reported like the allegation. S3 stated that he/she wouldn't have had a problem saying something or approaching R2. S4 stated that the allegation is not surprising because R1 will go behind the bistro bar even though R1 is not suppose enter the area, and R1 does not want R2 or S4 to say anything about it him/her. S4 stated that R1 goes out of his/her way to provoke R2, and R1 is taking things out of proportion. W1 has visited the facility 2-3 times weekly over the last two (2) years and has never witnessed any verbal harassment. S1 and S2 have agreed to speak with R1 and R2 individually about the facility's expectations. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the allegation; therefore, it is UNSUBSTANTIATED.

No citations issued during visit.

Exit interview conducted and a copy of this report provided to Claudia Redditt, Director of Business Administration
SUPERVISORS NAME: Yvonne Flores-Larios
LICENSING EVALUATOR NAME: Lisha Holmes
LICENSING EVALUATOR SIGNATURE:

DATE: 02/05/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/05/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 2