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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 019200682
Report Date: 03/04/2022
Date Signed: 03/04/2022 12:13:56 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
06/14/2021 and conducted by Evaluator Daisy Panlilio
COMPLAINT CONTROL NUMBER: 15-AS-20210614163419
FACILITY NAME:ELDRIDGE CARE HOMEFACILITY NUMBER:
019200682
ADMINISTRATOR:DIZON, MILLICENT RFACILITY TYPE:
735
ADDRESS:26601 ELDRIDGE AVENUETELEPHONE:
(510) 571-1980
CITY:HAYWARDSTATE: CAZIP CODE:
94544
CAPACITY:6CENSUS: 5DATE:
03/04/2022
UNANNOUNCEDTIME BEGAN:
11:30 AM
MET WITH:Millicent Dizon, Administrator
Melinda Balingit, Caregiver		TIME COMPLETED:
12:20 PM
ALLEGATION(S):
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Staff made sexual advances towards resident
INVESTIGATION FINDINGS:
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On 03/04/22 at 11:30 AM, Licensing Program Analyst (LPA) Daisy Panlilio arrived unannounced to deliver the investigation findings on the above allegation. LPA explained the purpose of the visit with administrator on the phone who authorized staff (S1) to act on her behalf and sign the reports.

Allegation: Staff made sexual advances towards resident
Investigation Finding: UNSUBSTANTIATED
On 6/15/2021, LPA Luisa Fontanilla initiated the 10-day investigation, obtained records and interviewed Staff 1 (S1). On 6/17/2021, LPA interviewed Client 1 (C1). Based on interview conducted, C1 states staff are good and fair. C1 denied any staff touching or making sexual advances towards C1. Continued on next page, LIC 9099-C
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Bennett Fong
LICENSING EVALUATOR NAME: Daisy Panlilio
LICENSING EVALUATOR SIGNATURE:

DATE: 03/04/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/04/2022
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 2
Control Number 15-AS-20210614163419
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: ELDRIDGE CARE HOME
FACILITY NUMBER: 019200682
VISIT DATE: 03/04/2022
NARRATIVE
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On 6/15/2021, LPA interviewed Administrator who denied having a staff working at the facility by the name as mentioned in the allegation. LPA reviewed the facility’s personnel record (LIC 500) and did not observe any staff with the name indicated in the complaint.
Based on interviews conducted and record review, the above allegation is unsubstantiated.
Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation(s) did or did not occur, therefore the allegation is unsubstantiated.

No deficiency observed during visit. Exit interview and copy of this report provided via email to administrator.
SUPERVISORS NAME: Bennett Fong
LICENSING EVALUATOR NAME: Daisy Panlilio
LICENSING EVALUATOR SIGNATURE:

DATE: 03/04/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/04/2022
LIC9099 (FAS) - (06/04)
Page: 2 of 2