Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 019200448
Report Date: 06/14/2016
Date Signed 06/14/2016 12:18:45 PM


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
06/02/2016 and conducted by Evaluator Bennett Fong
COMPLAINT CONTROL NUMBER: 15-SC-20160602111112
FACILITY NAME:POINT AT ROCKRIDGE, THEFACILITY NUMBER:
019200448
ADMINISTRATOR:KIRSTEN KORFHAGEFACILITY TYPE:
740
ADDRESS:4500 GILBERT STREETTELEPHONE:
(510) 658-9266
CITY:OAKLANDSTATE: CAZIP CODE:
94611
CAPACITY:186CENSUS: 153DATE:
06/14/2016
UNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:TIME COMPLETED:
12:30 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Facility had knowledge that a resident's dementia behavior was a danger to other residents and took no precautions - resulting in injury to another resident.

INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
LPA Jeremy Fong conducted an unannounced continuing complaint investigation, meeting with Administrator Kirsten Korfhage. LPA Jeremy Fong had conducted an investigation into the above allegation. While there was a known behavior of subject resident, the information obtained is insufficient to indicate that the facility had clear knowledge that the resident would be a danger to other residents. Facility also had been addressing the behaviors.

Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation(s) did or did not occur, therefore the allegation is inconclusive.
Inconclusive
Estimated Days of Completion:
SUPERVISOR'S NAME: Rajind BasiTELEPHONE: (510) 622-2621
LICENSING EVALUATOR NAME: Bennett FongTELEPHONE: 510-622-2625
LICENSING EVALUATOR SIGNATURE:

DATE: 06/14/2016
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/14/2016
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
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