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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 019200099
Report Date: 07/28/2022
Date Signed: 07/28/2022 06:42:28 PM

Substantiated


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
03/23/2021 and conducted by Evaluator Alicia Delmundo
COMPLAINT CONTROL NUMBER: 15-AS-20210323135713
FACILITY NAME:LADY OF MERCED CARE HOME, INC.FACILITY NUMBER:
019200099
ADMINISTRATOR:GERALDINE LARAFACILITY TYPE:
735
ADDRESS:26768 LAUDERDALE AVENUETELEPHONE:
(510) 785-8997
CITY:HAYWARDSTATE: CAZIP CODE:
94545
CAPACITY:6CENSUS: 3DATE:
07/28/2022
UNANNOUNCEDTIME BEGAN:
02:30 PM
MET WITH:Mercedita Lara/Licensee TIME COMPLETED:
06:45 PM
ALLEGATION(S):
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-Staff speak inappropriately towards client.

-Staff is mishandling client's personal funds.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Delmundo arrived unannounced to continue the investigation of the above allegations and close the complaint. LPA met with staff, Arthur Rommel Rodriguez. .At 2:42 pm, LPA called and left message on Mercedita Lara's (licensee) voice mail. Mercedita arrived at around 4:00 pm.

During the course of investigation, LPA obtained copies of staff schedule and client's Individual Program Plan; LIC602 Physician's Report and LIC405 Record of Client's/Resident's Safeguarded Cash Resources. LPA interviewed staff, clients and Regional Center of East Bay (RCEB) staff.

1. Allegation: staff speak inappropriately towards client.
Clients (C1 and C2) were interviewed and stated that staff at times yell at them. Staff (S2) denied yelling at any clients. During subsequent investigation, LPA in the presence of Geraldine Lara, administrator, personally observed staff S1 responded angrily to one of the clients when the client raised his voice.
..........continued on 9099C
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Bennett Fong
LICENSING EVALUATOR NAME: Alicia Delmundo
LICENSING EVALUATOR SIGNATURE:

DATE: 07/28/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/28/2022
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
Control Number 15-AS-20210323135713
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: LADY OF MERCED CARE HOME, INC.
FACILITY NUMBER: 019200099
VISIT DATE: 07/28/2022
NARRATIVE
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2. Allegation: staff is mishandling client's personal funds.
LPA interviewed clients and RCEB staff. LPA reviewed clients P&I money, and observed that client is charge for waste management fee for disposal of client's accumulated items.

Based on all the information gathered, the two allegations are substantiated. Failure to submit proof of corrections by plan of correction due dates and any repeat violation within 12-month period may result in civil penalty.

Deficiencies were discussed with Geraldine Lara, administrator, over the phone in the presence of Mercedita Lara. Plan and proof of corrections were discussed with Mercedita Lara.

Exit interview conducted. Appeal Rights, LIC9098 Proof of Correction form, and copy of this report provided.
SUPERVISORS NAME: Bennett Fong
LICENSING EVALUATOR NAME: Alicia Delmundo
LICENSING EVALUATOR SIGNATURE:

DATE: 07/28/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/28/2022
LIC9099 (FAS) - (06/04)
Page: 2 of 5
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
03/23/2021 and conducted by Evaluator Alicia Delmundo
COMPLAINT CONTROL NUMBER: 15-AS-20210323135713

FACILITY NAME:LADY OF MERCED CARE HOME, INC.FACILITY NUMBER:
019200099
ADMINISTRATOR:GERALDINE LARAFACILITY TYPE:
735
ADDRESS:26768 LAUDERDALE AVENUETELEPHONE:
(510) 785-8997
CITY:HAYWARDSTATE: CAZIP CODE:
94545
CAPACITY:6CENSUS: 3DATE:
07/28/2022
UNANNOUNCEDTIME BEGAN:
02:30 PM
MET WITH:Mercedita Lara/Licensee TIME COMPLETED:
06:45 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
-Client is being mistreated while in care.

-Staff is denying client access to food.
INVESTIGATION FINDINGS:
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2
3
4
5
6
7
8
9
10
11
12
13
Licensing Program Analyst (LPA) Delmundo arrived unannounced to continue the investigation of the above allegations and close the complaint. LPA met with staff, Arthur Rommel Rodriguez.At 2:42 pm. LPA called and left message on Mercedita Lara's (licensee) voice mail. Mercedita arrived at aroud 4:00 pm.

1. Allegation: client is being mistreated while in care
Client C1 indicated that staff mistreated him and he is told he is a liar. LPA interviewed staff (S2) and licensee who both denied mistreating C1 and other clients.

2. Staff is denying client access to food.
C1 indicated staff lock the cabinet where snacks are keot and the refrigerator. LPA interviewed client (C2) who indicated he has access to food and snacks. During the course of investigation, LPA observed the pantry with latch; however, it was not locked. LPA also observed clients taking snacks from the pantry.
......continued on 9099C
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Bennett Fong
LICENSING EVALUATOR NAME: Alicia Delmundo
LICENSING EVALUATOR SIGNATURE:

DATE: 07/28/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/28/2022
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-20210323135713
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: LADY OF MERCED CARE HOME, INC.
FACILITY NUMBER: 019200099
VISIT DATE: 07/28/2022
NARRATIVE
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Based on all the information obtained, the allegations of client is being mistreated while in care and staff is denying client access to food are unsubstantiated. A finding that the complaint is unsubstantiated means that although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violation occurred.

No deficiency cited,

Exit interview conducted and copy of this report provided to Mercedita Lara.
SUPERVISORS NAME: Bennett Fong
LICENSING EVALUATOR NAME: Alicia Delmundo
LICENSING EVALUATOR SIGNATURE:

DATE: 07/28/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/28/2022
LIC9099 (FAS) - (06/04)
Page: 4 of 5
Control Number 15-AS-20210323135713
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: LADY OF MERCED CARE HOME, INC.
FACILITY NUMBER: 019200099
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/28/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
08/11/2022
Section Cited
CCR
80072(a)(1)
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80072 Personal Rights
(a) Except for children’s residential facilities, each client shall have personal rights which include, but are not limited to, the following:(1) To be accorded dignity in his/her personal relationships with staff and other persons.
-This requirement is not met as evidenced by:
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Licensee to in-service the staff and submit copy of training topic with attendees signatures by 8/11/2022.
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-Based on observation and interviews, the licensee did not comply with the section above when staff spoke inappropriately at the client which posed personal right risk to client in care.
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Type B
08/11/2022
Section Cited
CCR
80026(
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80026 Safeguards for Cash Resources, Personal Property, and Valuables of Residents
(b) If such a client is accepted for or maintained in care, his/her cash resources, personal property, and valuables .........shall be handled by the licensee or facility staff, and shall be safeguarded in accordance with the requirements
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Administrator stated they will return the waste mangement fee back to client's P&I. Proof to be submitted by 8/11/2022.
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-This requirement is not met as evidenced by:

-Based on records review, the licensee did not comply with the section cited above by taking the waste management fee from client's P&I.
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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: Alicia Delmundo
LICENSING EVALUATOR SIGNATURE:

DATE: 07/28/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/28/2022
LIC9099 (FAS) - (06/04)
Page: 5 of 5