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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 079200855
Report Date: 06/06/2025
Date Signed: 06/06/2025 02:07:51 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
06/04/2025 and conducted by Evaluator Jill Clancy-Czuleger
COMPLAINT CONTROL NUMBER: 15-AS-20250604113955
FACILITY NAME:TREVISTA CONCORDFACILITY NUMBER:
079200855
ADMINISTRATOR:CLAWSON, DAVID JFACILITY TYPE:
740
ADDRESS:1081 MOHR LNTELEPHONE:
(925) 798-3900
CITY:CONCORDSTATE: CAZIP CODE:
94518
CAPACITY:160CENSUS: 118DATE:
06/06/2025
UNANNOUNCEDTIME BEGAN:
09:05 AM
MET WITH:David Clawson, Administrator TIME COMPLETED:
02:30 PM
ALLEGATION(S):
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9
Staff do not maintain facility sanitary
Staff do not serve residents food of good quality
INVESTIGATION FINDINGS:
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On 06/6/2025 at 09:05AM, Licensing Program Analysts (LPAs) J. Clancy-Czuleger arrived unannounced to deliver findings for the above allegations. LPA explained the purpose of the visit with Administrator David Clawson. During the initial 10-day complaint visit. LPA interviewed staff, and residents.

On the allegation: Staff do not serve residents food of good quality
Based on record review and interviews, it was found that there has not changed chiefs or food vendors since the change of management. Both S1 and S2 stated that the facility has a weekly menu, but the kitchen staff has an always available menu if any resident does not like the main meal of the day. One situation occurred with food service involving a new staff member, who re-served a plate of food that was already served to and denied by a resident. Management was notified and the server was trained proper food service.

Continued on LIC-9099C...
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Harpreet Humpal
LICENSING EVALUATOR NAME: Jill Clancy-Czuleger
LICENSING EVALUATOR SIGNATURE:

DATE: 06/06/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/06/2025
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 2
Control Number 15-AS-20250604113955
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: TREVISTA CONCORD
FACILITY NUMBER: 079200855
VISIT DATE: 06/06/2025
NARRATIVE
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...Continued from LIC-9099

On the allegation: Staff do not maintain facility sanitary
Based on observation and interviews the facility has 8 shower rooms on the first floor, and 12 rooms on the second floor with on suite showers. S1 stated that the shower rooms on the first floor get cleaned 3-4 times per week by the housekeeping staff. S4 stated that the resident rooms with showers get cleaned about three times per week but the residents are able to request additional cleaning as needed.

Although the allegations may have happened or are valid, there are not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegations are UNSUBSTANTIATED.

Exit interview conducted and a copy of this report provided.
SUPERVISORS NAME: Harpreet Humpal
LICENSING EVALUATOR NAME: Jill Clancy-Czuleger
LICENSING EVALUATOR SIGNATURE:

DATE: 06/06/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/06/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 2