019201143-11-20-2025-15-AS-YFLS-DNQRGW-20251124120124

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 019201143
Report Date: 11/20/2025
Date Signed: 11/20/2025 11:32:11 AM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
OAKLAND ASC, 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
09/17/2025 and conducted by Evaluator Ardalan Gharachorloo

COMPLAINT CONTROL NUMBER: 15-AS-20250917090638

FACILITY NAME:	ELEGANCE BERKELEY		FACILITY NUMBER:	019201143
ADMINISTRATOR:	DOMIZIO, ANNEMARIE E		FACILITY TYPE:	740
ADDRESS:	2100 SAN PABLO AVENUE		TELEPHONE:	(510) 788-1333
CITY:	BERKELEY	STATE: CA	ZIP CODE:	94710
CAPACITY:	120	CENSUS: 42	DATE:	11/20/2025
		UNANNOUNCED	TIME BEGAN:	10:30 AM
MET WITH:	Sarian Lichtenberger, Regional Operation Leader		TIME COMPLETED:	12:15 PM

ALLEGATION(S):

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Staff leave residents in soiled diaper for an extended period of time
Staff does not ensure adequate food options are available for residents with dietary restrictions

INVESTIGATION FINDINGS:

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On11/20/2025 at 10:30 AM, LPA's Ardalan Gharachorloo and David Doidge arrived unannounced to deliver finding for the above allegations. LPA met with Sarian Lichtenberger, Regional Operation Leader and explained the purpose of the visit.

Allegation: Staff leave residents in soiled diaper for an extended period of time - Unsubstantiated

On 9/18/2025, LPA initiated 10-day investigation, obtained records and interviewed staff and residents.
During the visit, LPA interviewed Resident 3 (R3). R3 was identified by RP as the resident who is left in soiled diapers and whose room smells so bad when opened. During the interview, R3 states staff are nice and helpful. And that staff come to assist R4, if needed.

While interviewing R3, LPA did not notice any urine smell. R4 appeared to be well groomed. R3 appeared excited about the performer coming for the day’s activity.

***CONTINUE ON 9099C***

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Yvonne Flores-Larios
LICENSING EVALUATOR NAME: Ardalan Gharachorloo
LICENSING EVALUATOR SIGNATURE:	DATE: 11/20/2025

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/20/2025

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-20250917090638

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
OAKLAND ASC, 1515 CLAY STREET, STE. 310
OAKLAND, CA 94612

FACILITY NAME: ELEGANCE BERKELEY	FACILITY NUMBER: 019201143
	VISIT DATE: 11/20/2025

NARRATIVE

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***CONTINUE FROM 9099***

During the visit, LPA with Justin Zackweski, Regional Director and LPA Lisha Holmes checked R3’s room. LPAs observed the room to be clean, organized and odor free.

Staff interviewed state incontinent residents get changed 2-3 times during each shift. The first check/change is done at the start of shift, then after lunch and before end of shift.

Allegation: Staff does not ensure adequate food options are available for residents with dietary restrictions - Unsubstantiated

During the course of investigation, LPA reviewed facility menus for the last three months. There are two types of menu: regular and alternate. Interim ED states the regular menu has always two options for the residents to choose from. And then the alternate menu which can be served to the residents anytime they prefer to eat food apart from the regular.

The information provided by the ED was confirmed by R3 who states that R3 has chosen the alternate menu a few times since living at the facility and everything is fine.

An interview was conducted with R4 who states that R4 has dietary restrictions – Kosher diet, which the facility does not accommodate. R4 states the facility does not provide Kosher foods. When asked if the facility was made aware of R4’s restrictions during the admission process, R4 stated the facility should know but did not provide any further information.

A review of R4’s medical assessment did not indicate any dietary restrictions or allergies. The report indicates R4 “has no special diet but has dietary preference.” The facility’s dietary board did not indicate R4’s name as one of the residents with dietary restrictions.

Based on interviews and record reviews conducted, the above allegations are unsubstantiated. Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegations are unsubstantiated.

A copy of this report was provided to Sarian Lichtenberger, Regional Operation Leader.

SUPERVISORS NAME: Yvonne Flores-Larios
LICENSING EVALUATOR NAME: Ardalan Gharachorloo
LICENSING EVALUATOR SIGNATURE:	DATE: 11/20/2025

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/20/2025

LIC9099 (FAS) - (06/04)

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