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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 015601366
Report Date: 07/15/2025
Date Signed: 07/15/2025 04:18:37 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
07/14/2025 and conducted by Evaluator Patricia Manalo
COMPLAINT CONTROL NUMBER: 15-AS-20250714143536
FACILITY NAME:FOOTPRINT CARE HOMEFACILITY NUMBER:
015601366
ADMINISTRATOR:ALMOCERA, SOLEDADFACILITY TYPE:
740
ADDRESS:4647 HANSEN AVENUETELEPHONE:
(510) 797-8719
CITY:FREMONTSTATE: CAZIP CODE:
94536
CAPACITY:6CENSUS: 3DATE:
07/15/2025
UNANNOUNCEDTIME BEGAN:
09:45 AM
MET WITH:Gene Messick, Direct Care StaffTIME COMPLETED:
12:30 PM
ALLEGATION(S):
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Facility accepted a resident that requires a higher level of care.
Facility staff is not tending to resident's health and care needs.
Facility increased resident's fees without any notification to the responsible party.
INVESTIGATION FINDINGS:
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On 07/15/2025, at 9:45 AM, Licensing Program Analysts (LPAs) P. Manalo and K. Nguyen arrived unannounced to conduct a complaint investigation and deliver findings on the above allegations. LPAs met with Direct Care Staff, Gene Messick and explained the purpose of the visit.


During the course of investigation, LPAs interviewed 3 staff and witness. LPAs reviewed documents including but not limited to Resident 1’s (R1’s) Admission Agreement, Appraisal Needs and Services Plan, After-Visit Summary, Identification and Emergency Information, Pre-Appraisal Evaluation, and Progress Notes.

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

DATE: 07/15/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/15/2025
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 4
Control Number 15-AS-20250714143536
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: FOOTPRINT CARE HOME
FACILITY NUMBER: 015601366
VISIT DATE: 07/15/2025
NARRATIVE
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Continue from LIC9099...

It was alleged that facility accepted a resident that requires a higher level of care. Interviews with staff all indicated they are not capable of providing the level of care that R1 needs. All staff stated that they have not received any training regarding R1’s care and the care should be done by a licensed professional.

It was alleged that facility staff is not tending to resident’s health and care needs. Record review of the After Visit Summary showed that R1 has been in and out of the hospital numerous times dated from October 2024 to July 2025. Interviews with S2 and S3 revealed that the facility obtains the After-Visit Summary after the resident returns from the hospital. However, they do not follow up with the after-care instructions from the summary to provide care for R1. Interview with W1 disclosed that R1 has been to the hospital multiple times since R1’s admission to the facility for R1’s health condition.

It was alleged that facility increased resident's fees without any notification to the responsible party. A review of R1’s Admission Agreement dated 07/19/2024 showed that the facility was charging the resident for a private room without a break down of how much each services cost. LPA interviewed W1 and stated that the facility increased R1’s rent without proper notice for R1 residing in the private room. W1 stated that there is no documentation of the increase of rent nor the breakdown of the services.

Based on LPA's information obtained during investigation, the preponderance of evidence standard has been met; therefore, the above allegation is found to be SUBSTANTIATED. California Code of Regulations, Title 22, are being cited on the attached LIC9099D.

Exit interview conducted. A copy of this report and appeal rights provided.
SUPERVISORS NAME: Yvonne Flores-Larios
LICENSING EVALUATOR NAME: Patricia Manalo
LICENSING EVALUATOR SIGNATURE:

DATE: 07/15/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/15/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 4
Control Number 15-AS-20250714143536
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: FOOTPRINT CARE HOME
FACILITY NUMBER: 015601366
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/15/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
08/06/2025
Section Cited
HSC
1568.03
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(b) ... a facility shall not accept or retain residents who require a higher level of care than the facility is authorized to provide. Persons who require 24-hour skilled nursing intervention shall not be appropriate for a residential care facility.
This requirement is not met as evidenced by:
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The Administrator will work with the resident and resident's POA on finding another placement for resident that can provide the resident's care needs. Proof of correction will be sent to CCLD by POC date.
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Based on record review and interview, the licensee did not comply with the section cited above by retaining a resident who needs a higher level of care which poses an immediate 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.
SUPERVISORS NAME: Yvonne Flores-Larios
LICENSING EVALUATOR NAME: Patricia Manalo
LICENSING EVALUATOR SIGNATURE:

DATE: 07/15/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/15/2025
LIC9099 (FAS) - (06/04)
Page: 3 of 4
Control Number 15-AS-20250714143536
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: FOOTPRINT CARE HOME
FACILITY NUMBER: 015601366
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/15/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
07/30/2025
Section Cited
CCR
87468.2(a)(4)
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(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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The Administrator agrees to self certify and review the resident's care plan. Proof of correction will be sent to CCLD by POC date.
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Based on interview, the licensee did not comply with the section above by not providing residents with basic care needs which poses a potential health and safety risk to persons in care.
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Type B
07/30/2025
Section Cited
HSC
1569.655
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(a) If a licensee of a residential care facility for the elderly increases the rates of fees for residents or makes increases in any of its rate structures for services, the licensee shall provide no less than 90 days’ prior written notice...
This requirement is not met as evidenced by:
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The Administrator will self-certify the regulation and send proof to CCLD by POC date.
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Based on record review, the licensee did not comply with the section above by not providing the resident an increase notice of rent which poses a potential 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: Yvonne Flores-Larios
LICENSING EVALUATOR NAME: Patricia Manalo
LICENSING EVALUATOR SIGNATURE:

DATE: 07/15/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/15/2025
LIC9099 (FAS) - (06/04)
Page: 4 of 4