019200682-7-20-2023-15-AS-KHOS-CURQX8-20230816123308

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 019200682
Report Date: 07/20/2023
Date Signed: 07/20/2023 06:20:00 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
03/01/2022 and conducted by Evaluator Alicia Delmundo

COMPLAINT CONTROL NUMBER: 15-AS-20220301161043

FACILITY NAME:	ELDRIDGE CARE HOME		FACILITY NUMBER:	019200682
ADMINISTRATOR:	DIZON, MILLICENT R		FACILITY TYPE:	735
ADDRESS:	26601 ELDRIDGE AVENUE		TELEPHONE:	(510) 571-1980
CITY:	HAYWARD	STATE: CA	ZIP CODE:	94544
CAPACITY:	6	CENSUS: 6	DATE:	07/20/2023
		UNANNOUNCED	TIME BEGAN:	03:40 PM
MET WITH:	Melinda Balingit/Staff		TIME COMPLETED:	06:20 PM

ALLEGATION(S):

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Staff did not return resident's (R1) personal items.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Delmundo arrived unannounced to continue the investigation of the above allegation, and close the complaint. LPA met with staff, Melinda Balingit. LPA called and spoke over the phone with Millicent Dizon, administrator, and informed the reason for call. Administrator stated she can not come to the facility. and authorized Melinda Balingit to sign and receive this report.

It was alleged that money was dispersed to the facility in 2021 to purchase cell phone and iPad for resident (R1). R1 was not a the facility for 8 months, and R1 reported that licensee confiscated the items. It was furher alleged that when RP requested the items back from the administrator, administrator said R1 sold the items.

...........continued on 9099C

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Bennett Fong
LICENSING EVALUATOR NAME: Alicia Delmundo
LICENSING EVALUATOR SIGNATURE:	DATE: 07/20/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/20/2023

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-20220301161043

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: 07/20/2023

NARRATIVE

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During the course on investigation, LPA conducted interviews, reviewed R1's records, and obtained copies of documents.

On 3/10/22 and on this day, 7/20/23, LPA interviewed staff (S1, S2, S3 and administrator) who all confirmed that R1 has cell phone and iPad and other electronic items. R1 has history of losing items when out in the community. S1, S2 and S3 denied taking the items from R1, and administrator stated she didn't confiscate them.

R1's LIC621 Client/Resident Personal Property And Valuables does not have the cell phone and iPad listed. LPA was not able to obtain information from R1 nor from the third party staff (W1 and W2) who took R1's personal belongings when R1 was discharged from the facility. Facility does not have list of R1's personal belongings that were given to W1 and/or W2.

Based on information obtained, the allegation of staff did not return resident's (R1) personal items is closed as unsubstantiated. An unsubstantiated findings means that although the allegation may have happened or is valid, there's not enough preponderance of evidence to prove that alleged violation occurred.

No deficiency cited.

Exit interview conducted, and copy of this report provided.

SUPERVISORS NAME: Bennett Fong
LICENSING EVALUATOR NAME: Alicia Delmundo
LICENSING EVALUATOR SIGNATURE:	DATE: 07/20/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/20/2023

LIC9099 (FAS) - (06/04)

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