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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 079201351
Report Date: 08/11/2025
Date Signed: 09/08/2025 02:22:58 PM

Substantiated


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
08/05/2025 and conducted by Evaluator James Sampair
PUBLIC
COMPLAINT CONTROL NUMBER: 15-AS-20250805113016
FACILITY NAME:BRIDGE VIEW SENIOR LIVINGFACILITY NUMBER:
079201351
ADMINISTRATOR:COSTELLO, JINGJING WANGFACILITY TYPE:
740
ADDRESS:390 EL DIVISADERO AVETELEPHONE:
(510) 612-2240
CITY:WALNUT CREEKSTATE: CAZIP CODE:
94598
CAPACITY:6CENSUS: 6DATE:
08/11/2025
UNANNOUNCEDTIME BEGAN:
11:45 AM
MET WITH:Administrator Jingjing Wang CostelloTIME COMPLETED:
05:30 PM
ALLEGATION(S):
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Staff are not allowing the resident to have visitors.
Staff are not allowing the resident to receive phone calls.
INVESTIGATION FINDINGS:
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On 8/11/2025, at 11:45 AM, Licensing Program Analyst (LPA) James Sampair arrived unannounced at the facility to investigate the allegations above. Upon entry into the facility, the LPA identified himself and stated the purpose of the visit to Administrator (ADM) Jingjing Wang Costello.

The LPA interviewed Witness W1, the ADM, Resident R1, Staff S1, and Staff S2. The LPA reviewed R1's Physician's Report (LIC 602A), R1's Medical and Financial Power of Attorney (POA) documents, and a letter dated 8/11/2025 from W4 (R1's estate attorney).

The complaint alleges that staff are not allowing R1 to have visitors.
R1 stated that he does have visitors, but was only able to identify Witness W2 as a visitor. The ADM, S1, and S2 stated those visitors included Witness W1, W2, and Witness W3, but W1 and W3 were no longer allowed to visit R1. The data collected supports the allegation.

Continued on LIC 9099-C . . .
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Harpreet Humpal
LICENSING EVALUATOR NAME: James Sampair
LICENSING EVALUATOR SIGNATURE:

DATE: 09/08/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/02/2025
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 3
Control Number 15-AS-20250805113016
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
OAKLAND ASC, 1515 CLAY STREET, STE. 310
OAKLAND, CA 94612
FACILITY NAME: BRIDGE VIEW SENIOR LIVING
FACILITY NUMBER: 079201351
VISIT DATE: 08/11/2025
NARRATIVE
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. . . Continued from LIC 9099

The complaint alleges that staff are not allowing R1 to receive phone calls.
R1 stated that he does receive phone calls, but was only able to identify Witness W2 as a caller. The ADM, S1, and S2 stated those callers included Witness W1, W2, and Witness W3, but W1 and W3 were no longer allowed to call R1. The data collected supports the allegation.

The preponderance of the evidence standard has been met, and the allegations are SUBSTANTIATED.

Deficiencies are cited under the California Code of Regulations listed on LIC 9099-D. Failure to submit proof of correction (POC) by plan of correction due date and/or any repeat deficiencies within a 12-month period may result in civil penalties.

Exit interview conducted, Appeal Rights, and a copy of this report provided.
SUPERVISORS NAME: Harpreet Humpal
LICENSING EVALUATOR NAME: James Sampair
LICENSING EVALUATOR SIGNATURE:

DATE: 09/08/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/08/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 15-AS-20250805113016
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
OAKLAND ASC, 1515 CLAY STREET, STE. 310
OAKLAND, CA 94612

FACILITY NAME: BRIDGE VIEW SENIOR LIVING
FACILITY NUMBER: 079201351
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/11/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
08/12/2025
Section Cited
CCR
87468.1(a)(21)
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87468.1 Personal Rights of Residents in All Facilities (a) Residents in all residential care facilities for the elderly shall have all of the following personal rights: (21) To consent to have their relatives and other individuals of their choosing visit during reasonable hours, privately, and without prior notice.
This requirement is not met as evidenced by:
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R1 no longer resides at the facility.
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ADM, S1, and S2 stated during interviews that W1 and W3 were not allowed to visit R1.
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Type A
08/12/2025
Section Cited
CCR
87468.1(a)(14)
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87468.1 Personal Rights of Residents in All Facilities (a) Residents in all residential care facilities for the elderly shall have all of the following personal rights: (14) To have reasonable access to telephones, to both make and receive confidential calls.
This requirement is not met as evidenced by:
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R1 no longer resides at the facility.
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ADM stated during interview that W1 and W3 were not allowed to speak to R1 by phone.
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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: Harpreet Humpal
LICENSING EVALUATOR NAME: James Sampair
LICENSING EVALUATOR SIGNATURE:

DATE: 09/08/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/08/2025
LIC9099 (FAS) - (06/04)
Page: 3 of 3