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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 015601051
Report Date: 07/28/2026
Date Signed: 07/28/2026 12:19:44 PM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
OAKLAND ASC, 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
07/23/2026 and conducted by Evaluator Patricia Manalo
COMPLAINT CONTROL NUMBER: 15-AS-20260723170950
FACILITY NAME:LA CONCEPCION RESIDENTIAL CARE HOMEFACILITY NUMBER:
015601051
ADMINISTRATOR:CONCEPCION, CRISTINAFACILITY TYPE:
740
ADDRESS:4419 JACINTO DRTELEPHONE:
(510) 574-0755
CITY:FREMONTSTATE: CAZIP CODE:
94536
CAPACITY:6CENSUS: 3DATE:
07/28/2026
UNANNOUNCEDTIME BEGAN:
08:25 AM
MET WITH:Cristina Concepcion, Administrator TIME COMPLETED:
12:40 PM
ALLEGATION(S):
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Staff inappropriately restrain resident.
Staff are not addressing resident's fall risk.

INVESTIGATION FINDINGS:
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On 07/28/2026 at 8:25 AM, Licensing Program Analyst (LPA) P.Manalo arrived unannounced to conduct the initial 10-day visit and delivered the findings on the above allegations. LPA met with Administrator (ADM), Cristina Concepcion and explained the purpose of the visit.

During the visit, LPA interviewed ADM, 2 residents, and 2 staff members.

LPA reviewed and obtained the following documents included but not limited to physician report (LIC602A), appraisal needs and services plan (LIC625), preplacement appraisal information (LIC603) dated 07/06/2026, and admission agreement dated 07/06/2026.

Allegation: Staff inappropriately restrain resident.

Continue to LIC9099-C...
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Yvonne Flores-Larios
LICENSING EVALUATOR NAME: Patricia Manalo
LICENSING EVALUATOR SIGNATURE:

DATE: 07/28/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/28/2026
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 5
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
OAKLAND ASC, 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
07/23/2026 and conducted by Evaluator Patricia Manalo
COMPLAINT CONTROL NUMBER: 15-AS-20260723170950

FACILITY NAME:LA CONCEPCION RESIDENTIAL CARE HOMEFACILITY NUMBER:
015601051
ADMINISTRATOR:CONCEPCION, CRISTINAFACILITY TYPE:
740
ADDRESS:4419 JACINTO DRTELEPHONE:
(510) 574-0755
CITY:FREMONTSTATE:CAZIP CODE:
94536
CAPACITY:6CENSUS: 3DATE:
07/28/2026
UNANNOUNCEDTIME BEGAN:
08:25 AM
MET WITH:Cristina Concepcion, Administrator TIME COMPLETED:
12:40 PM
ALLEGATION(S):
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Staff do not provide activities for resident.
Staff leave resident in soiled diaper for extended period of time.
INVESTIGATION FINDINGS:
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On 07/28/2026 at 8:55 AM, Licensing Program Analyst (LPA) P.Manalo arrived unannounced to conduct the initial 10-day visit and delivered the findings on the above allegations. LPA met with Administrator (ADM), Cristina Concepcion and explained the purpose of the visit.

LPA reviewed and obtained the following documents included but not limited to physician report (LIC602A), appraisal needs and services plan (LIC625), preplacement appraisal information (LIC603) dated 07/06/2026, and admission agreement dated 07/06/2026.

Allegation: Staff do not provide activities for residents.

Continue to LIC9099-C…
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Yvonne Flores-Larios
LICENSING EVALUATOR NAME: Patricia Manalo
LICENSING EVALUATOR SIGNATURE:

DATE: 07/28/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/28/2026
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 3 of 5
Control Number 15-AS-20260723170950
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
OAKLAND ASC, 1515 CLAY STREET, STE. 310
OAKLAND, CA 94612
FACILITY NAME: LA CONCEPCION RESIDENTIAL CARE HOME
FACILITY NUMBER: 015601051
VISIT DATE: 07/28/2026
NARRATIVE
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Continued from LIC9099…

Allegation: Staff do not provide activities for residents.

It was alleged that staff do not provide activities for residents. During the tour of the facility, LPA observed R2 listening to music on their radio. R2 stated that they like to listen to music and sit on the porch by the door. Interview with R3 stated that R3 likes to watch tv and walk around the backyard. R3 stated that staff will offer things such as Bingo, but R3 will decline because R3 is not interested in it. Interview with ADM, S1, and S2 stated that they will offer activities to residents but sometimes the residents don’t want to do activities. ADM and S2 stated that R1 would be offered to do activities or watch tv in the living room, however, ADM and S2 stated that R1 did not want to do that and would stay in R1’s room.

Based on interviews conducted, the above allegation that staff do not provide activities for residents 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 allegations are unsubstantiated.

Allegation: Staff leave resident in soiled diaper for extended period of time.

It was alleged that staff leave resident in soiled diaper for extended period of time. During the visit, R2 stated that when R2 needs to use the bathroom, R2 can ask the staff for help. R2 stated that they do not use the bathroom on their own, and staff will help them. R3 stated that they do not need assistance with using the bathroom and R3 is able to use the bathroom on their own. ADM, S1, and S2 stated that residents will be changed more than 3 times a day and will be changed if residents are wet or has a bowel movement.

Based on interviews conducted, the above allegation that staff leave resident in soiled diaper for extended period of time is 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 allegations are unsubstantiated.

No deficiencies noted. Exit interview conducted and a copy of this report provided.
SUPERVISORS NAME: Yvonne Flores-Larios
LICENSING EVALUATOR NAME: Patricia Manalo
LICENSING EVALUATOR SIGNATURE:

DATE: 07/28/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/28/2026
LIC9099 (FAS) - (06/04)
Page: 4 of 5
Control Number 15-AS-20260723170950
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
OAKLAND ASC, 1515 CLAY STREET, STE. 310
OAKLAND, CA 94612
FACILITY NAME: LA CONCEPCION RESIDENTIAL CARE HOME
FACILITY NUMBER: 015601051
VISIT DATE: 07/28/2026
NARRATIVE
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Continued from LIC9099...

It was alleged that staff inappropriately restrain resident. ADM stated that because R1 would slide down their bed, ADM placed two big chairs along with R1’s wheelchair in front of R1’s bed to prevent R1 from sliding down. Interview with S1 and S2 stated that sometimes they would place a chair in front of the residents' bed so that it could prevent the residents from falling. During the visit, LPA conducted a tour of the facility and observed a chair on the side of R2’s bed. ADM stated that we put the chair there so that R2 does not fall. R2 stated that R2 thinks that staff put a chair there so R2 does not get up by themselves.

Based on interviews conducted, the preponderance of evidence standard has been met, therefore the above allegation that staff inappropriately restrain a resident is found to be SUBSTANTIATED. California Code of Regulations (Title 22, Division 6, Chapter 8), is being cited on the attached LIC 9099D.

Allegation: Staff are not addressing resident’s fall risk.

It was alleged that staff are not addressing resident’s fall risk. ADM stated that R1 has had two falls since the beginning of the month when R1 moved to the facility but did not sustain any bruises or fracture. ADM stated that R1 would slide from their bed and paramedics needed to be contacted for lift support. LPA reviewed R1’s documents and did not observe an Appraisal Needs and Services Plan that addressed R1’s fall risk. LPA reviewed R1’s Preplacement Appraisal Information dated 07/06/2026 in which it did not state R1 being a fall risk. Interview with ADM, S1, and S2 stated that if a resident was a fall risk, staff would put chairs in front of their bed so that residents don't fall.

Based on interviews conducted, the preponderance of evidence standard has been met, therefore the above allegation that staff are not addressing resident’s fall risk is found to be SUBSTANTIATED. California Code of Regulations (Title 22, Division 6, Chapter 8), is being cited on the attached LIC 9099D.

The following deficiencies were observed (see LIC 809D) and cited from the California Code of Regulations, Title 22 and/or Health and Safety Code Failure to correct deficiencies by POC date may result in additional Civil Penalties.

Exit interview conducted with Administrator. Appeal Rights and a copy of this report provided.
SUPERVISORS NAME: Yvonne Flores-Larios
LICENSING EVALUATOR NAME: Patricia Manalo
LICENSING EVALUATOR SIGNATURE:

DATE: 07/28/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/28/2026
LIC9099 (FAS) - (06/04)
Page: 2 of 5
Control Number 15-AS-20260723170950
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
OAKLAND ASC, 1515 CLAY STREET, STE. 310
OAKLAND, CA 94612

FACILITY NAME: LA CONCEPCION RESIDENTIAL CARE HOME
FACILITY NUMBER: 015601051
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/28/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
08/11/2026
Section Cited
CCR
87468.2(a)(4)
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87468.2(a)(4)Additional Personal Rights of Residents in Privately Operated Facilities (4)To care, supervision, and services that meet their individual needs and are delivered by staff that are sufficient in numbers, qualifications, and competency to meet their needs.

This requirement is not met as evidenced by:
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By POC date, Administrator agrees to contact the residents' physicians to come up with a plan to address the falls. Administrator removed the chairs during today's visit.
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Based on observation and interviews, the licensee did not comply with the section cited above by placing chairs in residents room to prevent falls which posed a potential safety and personal rights risk to persons in care.
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Type B
08/11/2026
Section Cited
CCR
87463(b)
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87463(b)Reappraisals (b)The reappraisal shall document significant changes in the resident's physical, mental..functional condition, including those required to be documented as specified in Section 87466, Observation of the Resident.

This requirement is not met as evidenced by:
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By POC date, Administrator agrees to review the regulation and self certify. Administrator agrees to update residents' appraisal when there is a change in condition.
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Based on interviews and record review, the licensee did not comply with the section cited above when ADM did not address R1's fall risk which posed a potential health and safety 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.
SUPERVISOR'S NAME: Yvonne Flores-Larios
LICENSING EVALUATOR NAME: Patricia Manalo
LICENSING EVALUATOR SIGNATURE:

DATE: 07/28/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/28/2026
LIC9099 (FAS) - (06/04)
Page: 5 of 5