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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 079200801
Report Date: 12/23/2024
Date Signed: 12/23/2024 02:02:47 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
12/19/2024 and conducted by Evaluator Kelly Nguyen
COMPLAINT CONTROL NUMBER: 15-AS-20241219124423
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: 84DATE:
12/23/2024
UNANNOUNCEDTIME BEGAN:
10:45 AM
MET WITH:Richard Remigio, Executive DirectorTIME COMPLETED:
02:30 PM
ALLEGATION(S):
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Staff did not prevent a resident from physically abusing another resident resulting in injury
INVESTIGATION FINDINGS:
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On 12/23/2024 at 10:45AM, Licensing Program Analyst (LPA), K. Nguyen arrived unannounced to conduct an initial 10-day complaint investigation and deliver complaint findings for the allegation above. LPA met with Richard Remigio, Executive Director, Executive Director and explained the reason for the visit.
During the course of the investigation LPA interview staff, residents, toured facility and obtained and reviewed records.

Allegation: Staff did not prevent a resident from physically abusing another resident resulting in injury.

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

DATE: 12/23/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/23/2024
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-20241219124423
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: 12/23/2024
NARRATIVE
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Continue from LIC9099

It was alleged that staff did not prevent a resident from physically abusing another resident resulting in injury, however after records reviews, observation, and interview conducted reveals that R1 is with staff majority of the time due, confused, disoriented, aggressive behavior, and sun downing behavior. After the alleged incident facility conducted an internal investigation reveal that R1 being monitor by staff constantly for any physical or aggression R1 have or may have. Memory care director conducted an in service with all the staff and directed staff to pay attention to residents that have sun downing and to record keeping any sign or behavior. Interviewed with S1 revealed that staff conducts safety checks for all residents’ rooms every two hours. S2 also stated the residents are asked and encouraged to come out into the common areas to join activities. During the tour LPA observed R1 was being redirected by staff constantly, and staff is with R1 the entire time.

Based on interviews, observation, 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: Kelly Nguyen
LICENSING EVALUATOR SIGNATURE:

DATE: 12/23/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/23/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 2