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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 075601018
Report Date: 07/19/2024
Date Signed: 07/19/2024 02:02:50 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
07/18/2024 and conducted by Evaluator James Sampair
PUBLIC
COMPLAINT CONTROL NUMBER: 15-AS-20240718164002
FACILITY NAME:ABRAHAM REST HOMEFACILITY NUMBER:
075601018
ADMINISTRATOR:SANCHEZ, ANNETTEFACILITY TYPE:
740
ADDRESS:1148 FLOWERWOOD COURTTELEPHONE:
(925) 977-9743
CITY:WALNUT CREEKSTATE: CAZIP CODE:
94598
CAPACITY:6CENSUS: 4DATE:
07/19/2024
UNANNOUNCEDTIME BEGAN:
11:00 AM
MET WITH:Annette SanchezTIME COMPLETED:
02:30 PM
ALLEGATION(S):
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Staff left resident in soiled briefs for a period of time.
Staff neglects to provide resident proper care.
INVESTIGATION FINDINGS:
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On 07/19/2024 at approximately 11:00 AM, Licensing Program Analyst (LPA) James Sampair arrived unannounced to conduct the complaint investigation. Upon entry, the LPA informed Administrator (ADM) Annette Sanchez of the purpose of the visit.

The complaint alleges that staff left Resident R1 in soiled briefs for a period of time.
The LPA reviewed R1's records and interviewed Staff S1, the ADM, and Witness W1, all of whom directly cared for R1. Based on the data collected and reviewed, there was no proof to substantiate the allegation.

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

DATE: 07/19/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/19/2024
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-20240718164002
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: 07/19/2024
NARRATIVE
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(...Continued from LIC9099)

The complaint alleges that staff neglected to provide R1 with proper care.
The LPA reviewed R1's records and interviewed Staff S1, the ADM, and Witness W1, all of whom directly cared for R1. Based on the data collected and reviewed, there was no proof to substantiate the allegation.

Although the allegations may have happened, or are valid, there is not a preponderance of evidence to prove them; therefore, the allegation is UNSUBSTANTIATED.

Exit interview conducted. Appeal Rights and a copy of this report provided.
SUPERVISORS NAME: Harpreet Humpal
LICENSING EVALUATOR NAME: James Sampair
LICENSING EVALUATOR SIGNATURE:

DATE: 07/19/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/19/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 2