Chateau III

Type of visit: Required - 1 Year

On 08/26/2026 at 10:00 AM, Licensing Program Analysts (LPAs) L. Alexander and K. Nguyen arrived unannounced to conduct 1-Year Annual Required inspection. LPAs met with Executive Director (ED), Tracey Ingleman and explained the purpose of the visit. The facility’s fire clearance was approved for capacity of 175 residents all may be non-ambulatory. Hospice waiver for fourteen (14) residents. Bedridden fire clearance for six (6) on first floor only. LPAs toured the facility with ED including but not limited to 8 residents’ apartments, bathrooms, multiple activity rooms, kitchen, common area and courtyard. There are no bodies of water observed. Hallway temperature was maintained at 75 degrees F. LPAs observed lighting in all rooms are adequate for the comfort and safety of the residents. The hot water temperature in a sample of residents’ shared bathroom were measured at 102.4, 108.8, and 106.3 degrees Fahrenheit. Residents’ bathrooms are equipped with grab bars and non-skid mats. There is a minimum of one week supply of nonperishable and 2-day of perishable foods. Centrally stored medications, sharps and toxic are locked and inaccessible to residents in care. Report continue on LIC 809c... Report continued LIC 809-C... Emergency Disaster (LIC 610E) last updated on 6/4/26. Fire extinguisher last inspected on 3/13/26. Fire inspection was conducted on 7/23/26 by Contra Costa County Fire Protection. Fire Drill was last conducted on 8/8/26. At 11 am, LPAs reviewed 8 residents records. At 1 pm, LPAs reviewed 8 staff records and 8 of 8 have current first aid training and associated to the facility. At 12 pm, LPAs reviewed a sample of resident’s medications. No deficiencies cited during the visit. Exit interview conducted and a copy of this report provided.the state’s words, verbatim · CDSS document, Aug 26, 2026

Allegation investigated: Resident sustained a broken arm while in care Facility failed to provide adequate care to resident

On 11/18/2025 at 11:15 AM, Licensing Program Analyst (LPA) L. Alexander conducted a subsequent visit and met with Executive Director (ED), Tracey Ingleman, to deliver the findings of above allegations. LPA explained the purpose of the visit with ED. During investigation, the Department obtained the following documents from the facility – Resident (R) Registry, Staff (S) Roster, Physician's Reports for R1-R6, Incident Reports for R1-R2, Assessments, Care Plans for R1-R6, Admissions Agreements for R1-R2, Physician's Orders for R2-R6, Face Sheet/Health ID for R1-R6, and medical records for R1 The Department interviewed Staff (S), Residents (R) and Witnesses (W). LIC9099-C Continued... Unsubstantiated LIC9099-C (Page 2) Allegation: Resident sustained a broken arm while in care Investigation Finding: Unsubstantiated The Department found that on 10/10/2024, at or around 0555 hours, S1 found R1 on the floor of R1’s kitchenette when conducting an incontinence check. R1 reported that they had gotten up to get something to drink on their own. R1 did not press their pendant to request staff’s help. S1 called the overnight supervisor S2, who responded and assessed R1. R1 complained of pain and injury to their head and left arm. R1 was transported to John Muir Medical Center via ambulance. While in the ambulance, R1 reported that they stood up to try to get a pill and fell landing on their left shoulder and face and was unable to get up. R1 was also found to have a Urinary Tract Infection (UTI). R1 underwent a Computed Tomography (CT) scan, which showed a fracture of the left humeral head, neck, and proximal diaphysis. R1’s face was also bruised on the left side as well as their left shoulder. R1’s responsible party is aware of at least six falls and said most of R1’s falls were due to a history of UTIs. R1 has a wrist pendant that they can press to alert and request staff’s assistance. W1 stated that there are no real fall prevention methods in place for R1 other than frequent checks, escort assistance, and the wrist pendant. Staff interviewed vaguely recalled details of R1’s fall from 10/10/2024, but stated R1 got up on their own and did not press their pendant button to ask staff for help, despite being bed bound and unable to stand up or walk on their own. S2 said a family conference would be held and a resident’s care plan would be amended to add additional services when a resident falls more than three times within a 30-day period. LIC9099-C Continued... LIC9099-C (Page 3) The Department reviewed R1’s file and observed that while the MD report indicates R1 to have been a fall risk, there was no documented fall between 2/1/24 and the subject incident of 10/10/24. The records also indicate that from 9/1/24 and 11/30/24, there was 1 fall (the subject incident). The Department found that information obtained was insufficient to confirm that staff had not performed a need which resulted in the fall, injury, and hospitalization. Staff schedule indicates that 6 care staff were on duty at the time of the incident. The Department has investigated this allegation and although the allegation may have happened or is valid, there is not a preponderance of evidence to prove that the subject incident was specifically due to neglect. Therefore, the allegation is Unsubstantiated. Allegation: Facility failed to provide adequate care to resident Investigation Finding: Unsubstantiated The Department reviewed documentation indicating that R1 has sustained 16 falls at the facility since their admission in 2022. One Unusual Incident Report, dated 10/10/24, indicated that a caregiver found R1 on the floor in their room during an incontinence check. R1 complained of head and left arm pain/injury. Staff #3 (S3) contacted Staff #4 (S4), who then called 911. No other incidents were documented between 09/01/24 and 11/30/24. A review of R1’s Physician’s Report (dated 12/21/23) and Bi-Annual Assessment, (dated 12/03/24), indicates that R1 diagnosis is sepsis due to Urinary Tract Infection (UTI), has a history of frequent falls, history of Cerebral Vascular Accident (CVA) LIC9099-C Continued... LIC9099-C (Page 4) and utilizes multiple assistive devices, including glasses, half bed rails, hospital bed, pendant, raised toilet seat, shower bench, walker, and wheelchair. R1 cannot ambulate without assistance and requires staff to escort them for 30 minutes per day due to concerns regarding balance and gait. Records further note that R1 has sustained two or more falls within the past year, has expressed fear of falling, and has sustained injuries as a result of previous falls. It was also documented that R1 was not participating in the “Safely You Fall Monitoring Program.” Since admission on 04/22/22, R1 has sustained a total of 16 falls: five in 2022, seven in 2023, three in 2024, and one in 2025. On 11/18/25, record review and interviews with S1 and S2 confirmed that R1 was identified as a fall risk at admission. S1 stated that the community protocol requires a discussion with the resident’s responsible party if three falls occur within a 30-day period. S1 reported that R1’s falls did not meet this threshold, as they occurred sporadically. S1 further stated that staff implemented alert charting, full assessments, and hourly checks for R1. Safely Youwas offered to the responsible party, who declined participation. S1 also stated that R1’s current care plan includes “Full Care” for ADLs, medication management, continence care, and escort services. LIC9099-C Continued... LIC9099-C (Page 5) Based on records review, interviews conducted, and observations made, the Department has investigated the above allegations of “Resident sustained a broken arm while in care” and “Facility failed to provide adequate care to resident” to be unsubstantiated. A finding that the complaint allegations are unsubstantiated means that although the allegations may have happened or are valid, there is not a preponderance of the evidence to prove that the alleged violations occurred. Therefore, the allegations of Resident sustained a broken arm while in care and Facility failed to provide adequate care to resident is Unsubstantiated. Exit interview conducted and a copy of this report provided.the state’s words, verbatim · CDSS document, Nov 18, 2025 · control 15-AS-20241227153732

Allegation investigated: Licensee is not safeguarding residents' personal property.

On 09/04/2025 at 11:40 AM, Licensing Program Analyst (LPA) L. Alexander conducted a subsequent visit and met with Director of Residents Services, Sheila Roberts, to deliver the findings of above allegations. LPA explained the purpose of the visit with Director. Allegation: Licensee is not safeguarding residents' personal property. Finding: Substantiated On 12/11/2023 LPA interviewed Witness (W) in which W1 stated that one of the caregivers was stealing residents’ money. LPA reviewed police report regarding the alleged theft of property from residents. The report indicated that one of the caregivers confessed that they stole multiple checks and jewelry from some of the residents. Substantiated LIC9099-C (Page 2) Based on LPAs observations and interviews which were conducted and record reviews, the preponderance of evidence standard has been met, therefore the above allegations are found to be SUBSTANTIATED. California Code of Regulations (Title 22, Division 6, Chapter 8), are being cited on the attached LIC 9099D. Exit interview conducted. Appeal Rights and a copy of this report provided. LIC9099-C (Page 5) S4 stated assurance that the tracking is being monitored. Some of the resident LPA reviewed R1’s physician’s report (LIC602-A) and Individual Service Plan (dated 09/19/2023) which indicated that R1 needed staff to full assist with toileting approximately 30 minutes that was scheduled during AM, PM and NOC shifts. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is UNSUBSTANTIATED. Exit interview conducted and a copy of this report provided.the state’s words, verbatim · CDSS document, Sep 4, 2025 · control 15-AS-20231201153854

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87468.2(a)(25) · Plan of correction due date: Sep 5, 2025

87468.2 Additional Personal Rights of Residents in Privately Operated Facilities (a) Personal Rights of Residents in All Facilities, residents in privately operated residential care facilities for the elderly shall have all of the following personal rights: (25) To protection of their property from theft or loss according to Health and Safety Code sections 1569.152, 1569.153, and 1569.154. This requirement is not met as evidenced by: Based on record review and interviews, the licensee did not comply with the section cited above in by not protecting residents' property from theft or loss according to Health and Safety Code which poses a potential health, safety or personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Sep 4, 2025

Plan of correction: Administrator conducted Vet Training on elder abuse, personal rights in July 2025. In addition, new hire training covers elder abuse and resident's rights. DOJ roster is checked monthly. LPA reviewed all documents. Deficiency cleared.

Type of visit: Required - 1 Year

On 08/06/2025 at 2:00 PM, Licensing Program Analysts (LPAs) L. Alexander and K. Nguyen arrived unannounced to conduct a 1-Year Annual Required inspection. LPAs met with the Director of Residents Services (DRS), Sheila Roberts, and explained the purpose of the visit. Executive Director (ED), Tracey Ingleman, arrived approximately 30 minutes late. The facility’s fire clearance was approved for capacity of 175 residents all may be non-ambulatory. Hospice waiver for fourteen (14) residents. Bedridden fire clearance for six (6) on first floor only. Administrator Certificate # 6029374740 (renew on: 6/9/2025). LPA toured the facility with Tracey Ingleman ED and Sheila Roberts including but not limited to five (5) residents’ apartments, bathrooms, multiple activity rooms, kitchen, common area and courtyard. There are no bodies of water observed. LPA observe lighting in all rooms is adequate for the comfort and safety of the residents. Hallway temperature was maintained at 70- and 74-degrees F. The hot water temperature in a sample resident’s bathroom was measured at an average of 105 degrees Fahrenheit. Residents’ bathrooms are equipped with grab bars and non-skid mats. There is a minimum of one week supply of nonperishable and 2-day of perishable foods. Centrally stored medications, sharp and toxic chemicals are locked and inaccessible to residents in care. Fire Drill last conducted on June 11, 2025, and June 18, 2025, Maintenance on 1 bus( Registration from 6/30/2025 to 6/30/2026) and 1 wheelchair van updated(Registration 5/31/2025 to 5/31/2026). Emergency Disaster Plan last updated on 6/13/2025. Liability Insurance effective date: 7/1/2024 to 7/1 2026. The fire extinguisher last inspected 3/13/2025. LIC809-C Continued... LPA reviewed ten (10) residents records. LPA reviewed nine (9) staff records and 9 of 9 have current first aid training and are associated with the facility. Updated copies of the following documents were requested for facility file and are reviewed on 8/6/2025: LIC 308 Designation of Administrative Responsibility- Reviewed LIC 309 Administrative Organization- Reviewed LIC 500 Personnel Report- Reviewed LIC 610E Emergency Disaster Plan (with last page dated and signed)- Reviewed Copy of Liability Insurance- Reviewed No deficiencies cited during the visit. Exit interview conducted and a copy of this report provided.the state’s words, verbatim · CDSS document, Aug 6, 2025

Type of visit: Required - 1 Year

On 08/29/2024 at 11:45 AM, Licensing Program Analyst (LPA) L. Alexander arrived unannounced to conduct 1-Year Annual Required inspection. LPA met with Director of Residents Services (DRS), Sheila Roberts and explained the purpose of the visit. Executive Director (ED), Tracey Ingleman, arrived approximately 30 minutes later. The facility’s fire clearance was approved for capacity of 175 residents all may be non-ambulatory. Hospice waiver for fourteen (14) residents. Bedridden fire clearance for six (6) on first floor only. Administrator Certificate # 6029374740 Expires 07/07/2025. LPA toured the facility with ED including but not limited to five (5) residents apartments, bathrooms, multiple activity rooms, kitchen, common area and courtyard. There are no bodies of water observed. LPA observe lighting in all rooms are adequate for the comfort and safety of the residents. Hallway temperature was maintained at 75 and 74 degrees F. The hot water temperature in a sample of residents’ shared bathroom were measured at 107.1, 109.0, 104.8 degrees Fahrenheit. Residents’ bathrooms are equipped with grab bars and non-skid mats. There is a minimum of one week supply of nonperishable and 2-day of perishable foods. Centrally stored medications, sharps and toxic chemicals are locked and inaccessible to residents in care. Maintenance on six (6) buses and wheelchair vans updated. LPA reviewed eight (8) residents records. LPA reviewed nine (9) staff records and 9 of 9 have current first aid training and associated to the facility. LIC809-C Continued... LIC809-C Continued... Updated copies of the following documents were requested for facility file and are to be submitted to CCL by 09/05/2024: LIC 308 Designation of Administrative Responsibility LIC 309 Administrative Organization LIC 500 Personnel Report LIC 610E Emergency Disaster Plan (with last page dated and signed) Copy of Liability Insurance No deficiencies cited during visit. Exit interview conducted and a copy of this report provided.the state’s words, verbatim · CDSS document, Aug 29, 2024

The state marks this report as 3 pages; the online copy we transcribed has 2. You can request the full file from the county licensing office.

Type of visit: Case Management - Infectious Disease Outbreak

On 12/11/2023 at 3:30PM Licensing Program Analyst (LPA) Lori Alexander arrived unannounced to conduct a Case Management visit to follow-up on the Covid Positive cases reported to Community Care Licensing Division on 11/01, 11/07, 11/27, 11/30 and 12/06. LPA met with Executive Director (ED), Tracey Ingleman and explained the purpose of the visit. ED says they are in contact with the Contra Costa Public Health (CCPH) and have been advised by CCPH to test residents and staff every week until 2 weeks past of no positive test results. ED states that the recommendations from CCPH is that staff continues to wear masks, visitors don't have to wear a mask. Residents (assisted living) that are positive are to quarantine in their apartments for 7 days. There are no dining room restrictions (i.e., dining room closures). Staff (caregivers) are to wear PPE (gowns, N-95 masks, gloves) when they enter a Covid positive resident's room. ED states that they have signage posted outside the doors with carts that include PPE as well as the storage to down and remove PPE. ED stated that residents located in memory care are to also quarantine for 7 days but the residents tend to wander and therefore it is really difficult to isolate the residents. LIC809-C Continued... LIC809 Continued.... ED states that staff that test positive are to quarantine for 5 days and after having no symptoms and test negative the staff can return back to work. Staff that return after 5 days quarantine will have to wear a N-95 mask for 5 more additional days. No deficiencies cited during this visit. Exit interview conducted and a copy of this report provided.the state’s words, verbatim · CDSS document, Dec 11, 2023

Type of visit: Case Management - Incident

On 12/11/2023 at 4:30PM Licensing Program Analyst (LPA) Lori Alexander arrived unannounced to conduct a Case Management visit to follow-up on a death report received by Community Care Licensing Division on 11/13/2023. LPA met with Executive Director (ED), Tracey Ingleman and explained the purpose of the visit. R1 passed away on 11/06/2023 with an unknown cause of death. Death report stated that R1 had an unwitnessed fall on 11/06/23 at 12:30PM. The death report revealed that R1 passed away at the hospital on 11/06/2023. During today's visit LPA requested additional information pertaining to R1's file which included: Physician's report (LIC602) Appraisal Needs and Services Plan LPA was informed by ED that R1's family will obtain a copy of R1's death certificate and during the visit the copy was received. The Certificate of Death reveals that cardiopulmonary arrest was the immediate cause of death of R1. No deficiencies cited during this visit. Exit interview conducted and a copy of this report provided.the state’s words, verbatim · CDSS document, Dec 11, 2023

Type of visit: Case Management - Incident

On 12/11/2023 at 5:30PM Licensing Program Analyst (LPA) Lori Alexander conducted an unannounced Case Management visit regarding an incident that was reported to CCLD on 11/30/2023. LPA met with Executive Director, Tracey Ingleman, and explained the purpose of the visit. LPA interviewed S2 to get further details of the incident. S2 stated that the family contacted the facility and informed after reviewing their mother's bank account that they saw a check cashed for $3000.00. S2 further states that she received a text message from R1's son with an image of the cashed check of $3000.00. S2 stated that the person's name endorsed on the check was one of her staff (S1). S2 stated that she contacted Pleasant Hill PD and spoke with an officer in which they both collaborated when S1 would be back at work and the officer would come to the facility to speak to S1. On 11/30/23 S1 arrived at the facility for a staff training from 9pm to 10pm. S2 stated that she went to the training room to get S1 after the police arrived at the facility approx. 9:45pm. S2 stated that the officer spoke with S1 and made an arrest. LIC809-C Continued.... LIC809 Continued.... LPA collected documents pertinent to the incident report. Documents received: 1. an email from S3 2. a copy of text message received from S2 3. a copy of the cashed check 4. a copy of S1's Hire Form, Application Report, Form I-9 with attached copies of Social Security Card and USA Permanent Resident Card 5. Pleasant Hill Police Report #23-3842 No deficiencies issued during the visit. Exit interview conducted and a copy of this report was provided.the state’s words, verbatim · CDSS document, Dec 11, 2023