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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 079200801
Report Date: 06/12/2024
Date Signed: 06/12/2024 04:25:34 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
06/06/2024 and conducted by Evaluator Carol Fowler
COMPLAINT CONTROL NUMBER: 15-AS-20240606145424
FACILITY NAME:WESTMONT OF PINOLEFACILITY NUMBER:
079200801
ADMINISTRATOR:REMIGIO, RICHARDFACILITY TYPE:
740
ADDRESS:2850 ESTATES AVETELEPHONE:
(510) 758-1122
CITY:PINOLESTATE: CAZIP CODE:
94564
CAPACITY:100CENSUS: 69DATE:
06/12/2024
UNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:SHANECE TUPUOLA (MC) COORDINATORTIME COMPLETED:
04:00 PM
ALLEGATION(S):
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Residents are isolated due to lack of staff.
INVESTIGATION FINDINGS:
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On 06/12/2024 at 10:00AM, Licensing Program Analyst (LPA), Carol Fowler arrived unannounced to conduct an initial 10-day complaint investigation and deliver complaint findings for the allegation above. LPA met with Shanece Tupuola, Memory Care Coordinator and explained the reason for the visit

During the course of the investigation LPA interview staff, toured facility and obtained and reviewed records.

Allegation: Residents are isolated due to lack of staff.

Continue on LIC9099C
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Bennett Fong
LICENSING EVALUATOR NAME: Carol Fowler
LICENSING EVALUATOR SIGNATURE:

DATE: 06/12/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/12/2024
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-20240606145424
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: WESTMONT OF PINOLE
FACILITY NUMBER: 079200801
VISIT DATE: 06/12/2024
NARRATIVE
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Continue from LIC9099

Reporting party stated residents are being isolated due to lack of staffing. Record review reveals that memory care and assisted living was fully staffed on the dates in question. Interview with S1 revealed that staff conducts safety checks for all residents rooms every two hours. S1 also stated the residents are asked and encouraged to come out into the common areas to join activities. LPA toured the memory care location and witness residents participating in arts and crafts, having snacks, watching TV, listening to music and getting hair cuts.

Based on interviews and record review the Department has investigated the above allegation and found it to be Unsubstantiated.

Exit interview conducted and a copy of this report provided.
SUPERVISORS NAME: Bennett Fong
LICENSING EVALUATOR NAME: Carol Fowler
LICENSING EVALUATOR SIGNATURE:

DATE: 06/12/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/12/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 2