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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 075601018
Report Date: 07/26/2023
Date Signed: 07/26/2023 01:28:20 PM

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
07/18/2023 and conducted by Evaluator James Sampair
PUBLIC
COMPLAINT CONTROL NUMBER: 15-AS-20230718162825
FACILITY NAME:ABRAHAM REST HOMEFACILITY NUMBER:
075601018
ADMINISTRATOR:MARIA LORENZANAFACILITY TYPE:
740
ADDRESS:1148 FLOWERWOOD COURTTELEPHONE:
(925) 977-9743
CITY:WALNUT CREEKSTATE: CAZIP CODE:
94598
CAPACITY:6CENSUS: 6DATE:
07/26/2023
UNANNOUNCEDTIME BEGAN:
09:45 AM
MET WITH:Annette SanchezTIME COMPLETED:
01:45 PM
ALLEGATION(S):
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9
Licensee did not provide a refund to resident’s representative.
Licensee did not provide written notification of additional services when level of care changed.
Licensee did not provide written itemization of charges when level of care changed.
INVESTIGATION FINDINGS:
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On 07/26/2023 at 9:45 AM, Licensing Program Analyst (LPA) J. Sampair arrived unannounced to deliver the investigation findings. Upon arrival, LPA stated purpose of the visit to staff member Bertha Uriarte and Administrator (ADM) Annette Sanchez.

During the investigation, the LPA interviewed and reviewed documentation from R1's agent (Power of Attorney) with fiduciary responsiblities. LPA also reviewed documentation from and interviewed the ADM and staff member Bertha Uriarte. Listed below are the allegations and a brief explanation of the evidence upon which each finding was based:

(Continued on LIC9099-C...)
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Bennett Fong
LICENSING EVALUATOR NAME: James Sampair
LICENSING EVALUATOR SIGNATURE:

DATE: 07/26/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/26/2023
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-20230718162825
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: ABRAHAM REST HOME
FACILITY NUMBER: 075601018
VISIT DATE: 07/26/2023
NARRATIVE
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(...Continued from LIC9099)

Licensee did not provide a refund to resident’s representative.
Based on a review of financial records and text messages, R1's estate had leased the bed that was left in his room from Apria, so it was the responsibility of R1's estate to remove it from the facility. Records indicate that R1 died on 06/02/2023 and that the bed leased from Apria was not removed from the facility until 06/18/2023. However, the Licensee did not provide R1's estate with an invoice of the charges that had accrued during that time nor a final accounting of the services rendered or previous payments received from R1's estate so it was unclear what was the final status financially for R1's estate at the time the complaint was made..

Licensee did not provide written notification of additional services when level of care changed.
Based on a review of financial records and text messages, the ADM had provided written notification of additional services being provided to R1.

Licensee did not provide written itemization of charges when level of care changed.
Based on a review of financial records and text messages, the ADM had provided a written itemization of charges when the level of care changed.

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.

Exit interview was conducted with ADM. A copy of this report was provided via email.
SUPERVISORS NAME: Bennett Fong
LICENSING EVALUATOR NAME: James Sampair
LICENSING EVALUATOR SIGNATURE:

DATE: 07/26/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/26/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 2