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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 015600413
Report Date: 12/09/2025
Date Signed: 12/09/2025 03:26:21 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
10/06/2025 and conducted by Evaluator Gregory Clark
COMPLAINT CONTROL NUMBER: 15-AS-20251006151105
FACILITY NAME:BELLAKEN GARDENFACILITY NUMBER:
015600413
ADMINISTRATOR:BELINDA LEUNGFACILITY TYPE:
740
ADDRESS:2780 26TH AVENUETELEPHONE:
(510) 536-1838
CITY:OAKLANDSTATE: CAZIP CODE:
94601
CAPACITY:58CENSUS: 58DATE:
12/09/2025
UNANNOUNCEDTIME BEGAN:
02:30 PM
MET WITH:Jeffery Tong, AdministratorTIME COMPLETED:
03:45 PM
ALLEGATION(S):
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Lack of Supervision

INVESTIGATION FINDINGS:
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On 12/09/25 at 2:30 p.m., Licensing Program Analyst (LPA) Greg Clark arrived unannounced to conduct an initial 10-day complaint investigation and deliver findings in regard to the allegation above. LPA met with Jeffery Tong, Administrator and explained the purpose of the visit.

R1 was admitted to the facility on 5/11/23 with a diagnosis of dementia. All the facility staff reported that R1 is a quiet resident and keeps to herself mostly in her room. R1 does attend Center for Elders Independence once a week. Facility staff also report that R1 has never expressed to them any concerns about other residents bothering her.

***continues on LIC9099C**
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Yvonne Flores-Larios
LICENSING EVALUATOR NAME: Gregory Clark
LICENSING EVALUATOR SIGNATURE:

DATE: 12/09/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/09/2025
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-20251006151105
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: BELLAKEN GARDEN
FACILITY NUMBER: 015600413
VISIT DATE: 12/09/2025
NARRATIVE
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***report from LIC9099***

R1 lives on the third floor of the facility. Review of the facility’s staff schedule revealed that there are 3 staff on duty from 6 AM till 11 PM and 2 staff on duty from 11 PM to 6 AM on the third floor. S1 and S4 both stated that they feel this is an adequate number of staff and they have not had any issues on the overnight shift.

LPA interviewed R1 in her room at the facility. R1 was pleasant and neatly dressed. R1 reported that she likes living at the facility and that the staff help clean her when she needs help. LPA asked if any male resident or staff have ever touched her and R1 replied “no”.

This agency has investigated the complaint alleging lack of supervision. We have found that the complaint was unsubstantiated. 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, a copy of this report provided.

SUPERVISORS NAME: Yvonne Flores-Larios
LICENSING EVALUATOR NAME: Gregory Clark
LICENSING EVALUATOR SIGNATURE:

DATE: 12/09/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/09/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 2