019201143-2-5-2025-15-AS-YFLS-DE2UFB-20250219143228

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 019201143
Report Date: 01/02/2025
Date Signed: 02/05/2025 05:02:26 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-20241223152240

FACILITY NAME:	ELEGANCE BERKELEY		FACILITY NUMBER:	019201143
ADMINISTRATOR:	COE, ROBERT		FACILITY TYPE:	740
ADDRESS:	2100 SAN PABLO AVENUE		TELEPHONE:	(510) 788-1333
CITY:	BERKELEY	STATE: CA	ZIP CODE:	94710
CAPACITY:	120	CENSUS: 47	DATE:	01/02/2025
		UNANNOUNCED	TIME BEGAN:	03:00 PM
MET WITH:	Claudia Redditt, Director of Business Administration		TIME COMPLETED:	05:45 PM

ALLEGATION(S):

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Staff did not store an adequate amount of milk for residents.

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 store an adequate amount of milk for residents.
UNSUBSTANTIATED.
During the course of the investigation and visit, LPA and ED toured the bistro bar and kitchen, freezer, cold and dry storage area. LPA interviewed Staff (S1, S2, S3, S4, S5, S6, S7, S8). LPA requested and reviewed the facility's vendor purchase orders from Newport Fish Co, PA-Vesta San Francisco, and Sysco-San Francisco.
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)

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Control Number 15-AS-20241223152240

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, W1 reported that on 12/23/24 he/she learned from about four (4) care staff that the residents were being served cereal with milk that had water inside of the milk. S2 stated that a new chef has been hired, and in the interim S2 is assisting the kitchen and has made purchases specifically for milk on 12/23/24 from Mi Tierra Foods located adjacent to the facility, the prior purchase was from the vendor Sysco-San Francisco on 12/21/24, and the following purchases were made 12/28/24 and 01/02/24. While touring the facility there was a half of a gallon milk present; however, the delivery arrived during the visit just after the purchase from Mi Tierra Foods around 11:00 AM on 01/02/24. S6 stated that the milk was probably low-fat. S7 stated that the facility does not do that, does serve milk with have the cream, whole milk or 2% fat. S8 stated the milk is probably 2% fat. S4 and S5 said they've never heard of the milk being watered down. S1 stated that the local Ombudsman toured the facility on 12/31/24 to view the dry and cold storage goods without any further recommendations. To date the facility has a sufficient variety, quality and quantity of perishable and non-perishable foods on the premises to meet the dietary needs of the residents. 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)

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