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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 01:05:16 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
05/16/2024 and conducted by Evaluator James Sampair
PUBLIC
COMPLAINT CONTROL NUMBER: 15-AS-20240516161048
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: 4DATE:
07/19/2024
UNANNOUNCEDTIME BEGAN:
11:00 AM
MET WITH:Annette SanchezTIME COMPLETED:
12:30 PM
ALLEGATION(S):
1
2
3
4
5
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7
8
9
Family was not provided detailed explanation of addional services, inlcuding itemization of charges
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
On 07/19/2024 at approximately 11:30 AM, Licensing Program Analyst (LPA) James Sampair arrived unannounced to deliver the investigation findings. Upon entry, the LPA informed Administrator (ADM) Annette Sanchez of the purpose of the visit.

The complaint alleges that family not provided detailed explanation of additional services nor itemization of charges. After interviews of the ADM and staff member S1 and a thorough review of R1’s records and communications between the staff and family member W1 who served as R1's financial agent, the LPA confirmed that detailed explanations of additional services and an itemization of charges had been provided by the facility to the family.

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.
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)
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