015600526-10-25-2024-15-AS-KHOS-DAGRUB-20241028131937

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 015600526
Report Date: 10/24/2024
Date Signed: 10/25/2024 11:34:19 AM

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
10/15/2024 and conducted by Evaluator Gregory Clark

COMPLAINT CONTROL NUMBER: 15-AS-20241015103505

FACILITY NAME:	ELDERS INN ON WEBSTER		FACILITY NUMBER:	015600526
ADMINISTRATOR:	MARIE ANN LAGASCA		FACILITY TYPE:	740
ADDRESS:	1721 WEBSTER STREET		TELEPHONE:	(510) 521-9200
CITY:	ALAMEDA	STATE: CA	ZIP CODE:	94501
CAPACITY:	60	CENSUS: 40	DATE:	10/24/2024
		UNANNOUNCED	TIME BEGAN:	02:30 PM
MET WITH:	Rolinda Noquillo, Administrator		TIME COMPLETED:	03:30 PM

ALLEGATION(S):

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Staff yell at residents

INVESTIGATION FINDINGS:

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On 10/24/24 at 2:00 p.m., Licensing Program Analyst (LPA) Greg Clark arrived unannounced to deliver findings in regard to the allegation above. LPA met with Rolinda Noquillo, Administrator and explained the purpose of the visit.

During the visit LPA Interviewed 4 facility staff and 5 facility residents.

Staff reported that they receive training in the proper way to speak to the residents. The training also including resident rights. All staff reported that they have never heard any staff yell or speak inappropriately to the residents.

***report continues on LIC9099C***

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Yvonne Flores-Larios	TELEPHONE: (510) 286-0517
LICENSING EVALUATOR NAME: Gregory Clark	TELEPHONE: 510-285-3927
LICENSING EVALUATOR SIGNATURE:	DATE: 10/24/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/24/2024

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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Control Number 15-AS-20241015103505

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: ELDERS INN ON WEBSTER	FACILITY NUMBER: 015600526
	VISIT DATE: 10/24/2024

NARRATIVE

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***report continues from LIC9099***

Residents interviewed told LPA that they have never been yelled at or spoken to inappropriately by the staff. They all said that the staff treat them with respect.

This agency has investigated the complaint alleging staff yell at residents. 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.

SUPERVISOR'S NAME: Yvonne Flores-Larios	TELEPHONE: (510) 286-0517
LICENSING EVALUATOR NAME: Gregory Clark	TELEPHONE: 510-285-3927
LICENSING EVALUATOR SIGNATURE:	DATE: 10/24/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/24/2024

LIC9099 (FAS) - (06/04)

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