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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 015600148
Report Date: 05/07/2025
Date Signed: 05/07/2025 04:16:37 PM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
E BAY DELTA AC/SC, 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
04/30/2025 and conducted by Evaluator Lori Alexander-Washington
PUBLIC
COMPLAINT CONTROL NUMBER: 15-AS-20250430190433
FACILITY NAME:ROSEGATEFACILITY NUMBER:
015600148
ADMINISTRATOR:LEUNG, BELINDAFACILITY TYPE:
740
ADDRESS:1345 CLARKE STREETTELEPHONE:
(510) 483-0150
CITY:SAN LEANDROSTATE: CAZIP CODE:
94577
CAPACITY:40CENSUS: 36DATE:
05/07/2025
UNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Jeffrey Tong, AdministratorTIME COMPLETED:
01:30 PM
ALLEGATION(S):
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Facility does not have a call system for residents to seek assistance from staff
Staff did not ensure resident was provided a chair
INVESTIGATION FINDINGS:
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On 05/07/2025 at 9:30 am, Licensing Program Analysts (LPAs) L. Alexander and Y. Brown arrived unannounced to conduct initial 10-day complaint visit for the above allegations. LPAs met with Facility Manager, lrene DeLeon, and explained the reason for the visit. Irene phoned Administrator, Jeffrey Tong, to inform. Jeffrey arrived shortly after.

LPAs obtained documents: Resident Registry and Staff Roster.




LIC9099-C Continued...
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Bennett Fong
LICENSING EVALUATOR NAME: Lori Alexander-Washington
LICENSING EVALUATOR SIGNATURE:

DATE: 05/07/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/07/2025
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-20250430190433
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
E BAY DELTA AC/SC, 1515 CLAY STREET, STE. 310
OAKLAND, CA 94612
FACILITY NAME: ROSEGATE
FACILITY NUMBER: 015600148
VISIT DATE: 05/07/2025
NARRATIVE
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Allegation: Facility does not have a call system for residents to seek assistance from staff
Finding: Substantiated

On 05/07/2025 LPAs interviewed Residents (R) R2, R3, R4 and R5 all stated that the call system does not work and that they have to find someone for assistance. LPAs interviewed Staff (S) S1 and S2 that stated they have a call system with an pendant to where a resident wears around their neck, presses the button and the button sends an alert to a voice system that calls the room number. S1 stated that the caregiver will go to the call system and re-set the system for that particular resident. LPA's toured the facility and observed that there were not any functioning call system and that only a few residents had the call pendant. S2 stated that only a few residents have a call pendant if they feel that they can press and use the pendant.

Allegation: Staff did not ensure resident was provided a chair
Finding: Substantiated

On 05/07/2025 LPAs toured the facility and observed that there were one (1) to zero (0) chair in each shared resident bedroom. S1 and S2 observed that there were not any chairs and started bringing chairs to the rooms.

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.
SUPERVISORS NAME: Bennett Fong
LICENSING EVALUATOR NAME: Lori Alexander-Washington
LICENSING EVALUATOR SIGNATURE:

DATE: 05/07/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/07/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 15-AS-20250430190433
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
E BAY DELTA AC/SC, 1515 CLAY STREET, STE. 310
OAKLAND, CA 94612

FACILITY NAME: ROSEGATE
FACILITY NUMBER: 015600148
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/07/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
05/21/2025
Section Cited
CCR
87303(i)(1)
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87303 Maintenance and Operation (i) Facilities shall have signal systems which shall meet the following criteria: (1) All facilities licensed for 16 or more ...shall have a signal system which shall:

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Administrator agrees to provide call pendants for all residents and submit a report with assigned pendant to each resident to CCLD by POC due date.
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Based on observation and interview the licensee did not comply with the section cited above by not having a working signal system including but not limited to a pendant call button for all residents which poses a potential health, safety or personal rights risk to persons in care.

This requirement is not met as evidence by:
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Type B
05/21/2025
Section Cited
CCR
87307(a)(3)(B)
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(a) Living accommodations and grounds...(3)Equipment...necessary(B) Bedroom furniture, which shall include, for each resident, a chair, night stand, a lamp, or lights sufficient for reading, and a chest of drawers.

This requirement is not met as evidence by:
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Administrator agrees to create a list of residents rooms with required furniture and will submit a checklist rounds for 2 weeks to CCLD by POC due date.
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Based on observation and interview the licensee did not comply with the section cited above by not having bedroom furniture including but not limited to having chairs in each room, lights sufficient for reading, and a chest of drawers for all residents which poses a potential health, safety or personal rights risk to persons in care.
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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: Lori Alexander-Washington
LICENSING EVALUATOR SIGNATURE:

DATE: 05/07/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/07/2025
LIC9099 (FAS) - (06/04)
Page: 3 of 3