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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 079200844
Report Date: 11/17/2023
Date Signed: 07/02/2025 04:48:29 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
11/13/2023 and conducted by Evaluator Alicia Delmundo
COMPLAINT CONTROL NUMBER: 15-AS-20231113131644
FACILITY NAME:SPYGLASS SENIOR VILLA IFACILITY NUMBER:
079200844
ADMINISTRATOR:SHARMA, RAKHEEFACILITY TYPE:
740
ADDRESS:39 CALLA CTTELEPHONE:
(415) 630-0266
CITY:OAKLEYSTATE: CAZIP CODE:
94561
CAPACITY:6CENSUS: 6DATE:
11/17/2023
UNANNOUNCEDTIME BEGAN:
11:15 AM
MET WITH:Rhakee Sharma/Administrator and
Rhonette Santos/Co-administratpr		TIME COMPLETED:
06:20 PM
ALLEGATION(S):
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Staff (S1) yells at resident in care.
INVESTIGATION FINDINGS:
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 ***THIS IS AN AMENDMENT OF REPORT DATED 11/17/2023****
At 11:15 am, Licensing Program Analyst (LPA) Delmundo arrived unannounced to investigate the above allegattion. LPA was granted entry by Sylvia Nerona, staff. Staf called and LPA spoke with Rhakee Sharma, administrator, over the phone and informed the reason for visit. Administrator arrived after about 50 minutres.

During today's investigation, LPA reviewed residents' files and conducted interviews.

Two of the staff interviewed stated they have not worked with S1 while the other staff stated not observing S1 yelled at any of the residents.


.......continued on 9099C
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Bennett Fong
LICENSING EVALUATOR NAME: Alicia Delmundo
LICENSING EVALUATOR SIGNATURE:

DATE: 07/02/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/02/2025
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 5
Control Number 15-AS-20231113131644
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: SPYGLASS SENIOR VILLA I
FACILITY NUMBER: 079200844
VISIT DATE: 11/17/2023
NARRATIVE
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Staff (S1) stated he has throat problem and denied yelling at any residents. One of the 3 residents (R3) interviewed stated that although S1 never yelled at R3, R3's head set is on at times and may not hear S1 yelled at others. The other 2 residents stated S1 yelled at them. An individual (W4) was interviewed and stated that when one of the resident who is no longer at facility rang the buzzer several times, the staff who no longer works at the facility said to the resident, "Okay, okay" in a different tone.

Based on the information obtained, the allegation is unsubstantiated.

Exit interview conducted. Appeal Rights, LIC9098 Proof of Correction form and copy of this report provided.
SUPERVISORS NAME: Bennett Fong
LICENSING EVALUATOR NAME: Alicia Delmundo
LICENSING EVALUATOR SIGNATURE:

DATE: 07/02/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/02/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 5
Control Number 15-AS-20231113131644
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: SPYGLASS SENIOR VILLA I
FACILITY NUMBER: 079200844
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/17/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Deficiency Dismissed
Type B
12/01/2023
Section Cited
CCR
00000
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ยง1569.269 Enumerated rights; severability (a) Residents of residential care facilities for the elderly shall have all of the following rights:
(1) To be accorded dignity in their personal relationships with staff, residents, and other persons.
-This requirement is not met as evidenced by:
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xxxxx
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xxxxxx
Deficiency deleted.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISORS NAME: Bennett Fong
LICENSING EVALUATOR NAME: Alicia Delmundo
LICENSING EVALUATOR SIGNATURE:

DATE: 07/02/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/02/2025
LIC9099 (FAS) - (06/04)
Page: 3 of 5
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
11/13/2023 and conducted by Evaluator Alicia Delmundo
COMPLAINT CONTROL NUMBER: 15-AS-20231113131644

FACILITY NAME:SPYGLASS SENIOR VILLA IFACILITY NUMBER:
079200844
ADMINISTRATOR:SHARMA, RAKHEEFACILITY TYPE:
740
ADDRESS:39 CALLA CTTELEPHONE:
(415) 630-0266
CITY:OAKLEYSTATE: CAZIP CODE:
94561
CAPACITY:6CENSUS: 6DATE:
11/17/2023
UNANNOUNCEDTIME BEGAN:
11:15 AM
MET WITH:Rhakee Sharma/Administrator and
Rhonette Santos/Co-administratpr		TIME COMPLETED:
06:20 PM
ALLEGATION(S):
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-Staff handles resident in a rough manner.

-Staff speaks to resident in an inappropriate manner.

-Staff are unable to communicate with residents due to language barrier.
INVESTIGATION FINDINGS:
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At 11:15 am, Licensing Program Analyst (LPA) Delmundo arrived unannounced to investigate the above allegattion. LPA was granter entry by Sylvia Nerona, staff. Staf called and LPA spoke with Rhakee Sharma, administrator, over the phone. and informed the reason for visit. Administrator arrived after about 50 minutres.

During today's investigation, LPA reviewed residents records and conducted interviews.

Allegation: Staff handles resident in a rough manner.
It was alleged that resident (R1) is cared for forcefully by a staff (S1). It was further alleged that R1 felt S1 purposely hit R1's head on the wall while bathing R1, wiped poop on R1's nose, and threw R1 on the bed when caring for R1.

.....continued on 9099C
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Bennett Fong
LICENSING EVALUATOR NAME: Alicia Delmundo
LICENSING EVALUATOR SIGNATURE:

DATE: 11/17/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/17/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 4 of 5
Control Number 15-AS-20231113131644
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: SPYGLASS SENIOR VILLA I
FACILITY NUMBER: 079200844
VISIT DATE: 11/17/2023
NARRATIVE
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Although R1 confirmed the allegation, all 4 staff interviewed stated they were never rough in assisting and/or handling residents. Three individuals (W1, W2, W3) who come to the facility to visit stated not observing S1 and/or other staff handle residents in a rough manner. The other 2 residents stated the staff are not rough in assisting them.

Allegation: Staff speaks to resident in an inappropriate manner.
It was alleged that S1 told resident R1 that S1 wishes R1 would die already.

LPA interviewed S1, and S1 stated R1 fell from bed before and when S1 sees R1 sleeping with bed inclined, S1 tells R1 that R1 may fall again and break his neck. This may have been misinterpreted by R1. The other 3 staff and 2 out of 3 residents interviewed stated all the staff never talked to them inappropriately.

Allegation: Staff are unable to communicate with residents due to language barrier.
Although it was alleged that a family member felt the complaint is possibly because of the language barrier, staff were able to communicate when LPA interviewed all 4 staff in English. LPA observed all to them able to express themselves and able to communicate with the administrator and residents. All 3 residents and 2 family members stated all the staff are able to communicate with them in English and they understand them.

Based on all information gathered, the allegations of 'Staff handles resident in a rough manner', 'Staff speaks to resident in an inappropriate manner', and ' Staff are unable to communicate with residents due to language barrier' are closed as unsubstantiated. A finding that a complaint is unsubstantiated means that although the allegations may have happened or are valid, there are not enough preponderance of evidence to prove that the alleged violations occurred.

No deficiency cited.

Exit interview conducted and copy of this report provided.
SUPERVISORS NAME: Bennett Fong
LICENSING EVALUATOR NAME: Alicia Delmundo
LICENSING EVALUATOR SIGNATURE:

DATE: 11/17/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/17/2023
LIC9099 (FAS) - (06/04)
Page: 5 of 5