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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 019200682
Report Date: 09/03/2025
Date Signed: 09/03/2025 03:54:16 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
08/27/2025 and conducted by Evaluator Kelly Nguyen
COMPLAINT CONTROL NUMBER: 15-AS-20250827094527
FACILITY NAME:ELDRIDGE CARE HOMEFACILITY NUMBER:
019200682
ADMINISTRATOR:DIZON, MILLICENT RFACILITY TYPE:
735
ADDRESS:26601 ELDRIDGE AVENUETELEPHONE:
(510) 397-2056
CITY:HAYWARDSTATE: CAZIP CODE:
94544
CAPACITY:6CENSUS: 6DATE:
09/03/2025
UNANNOUNCEDTIME BEGAN:
02:20 PM
MET WITH:Millcent R Dizon, AdministratorTIME COMPLETED:
04:30 PM
ALLEGATION(S):
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Staff do not ensure facility is free from pests
INVESTIGATION FINDINGS:
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On 9/3/2025 at around 2:15 pm, Licensing Program Analysts (LPAs) K. Nguyen and P. Manalo arrived unannounced to conduct and deliver finding on the above allegation and met with Administrator (ADM), Millcent R Dizon. LPAs explained to the purpose of the visit to ADM.

During the course of investigation, LPAs conducted 10-day visit and interviewed Staff 1 (S1) and Staff 2 (S2) and Staff 3 (S3) 9/3/2025. LPAs interviewed Client 1 (C1), Client 2 (C2), and Client 3 (C3).
Based on interviews conducted with S1, S2, and S3, all stated that there are cockroaches at nighttime. C1 and C2 stated C1 and C2 saw cockroaches in the kitchen at nighttime.

Based on interviews conducted, the preponderance of evidence standard has been met, therefore the above allegation is found to be substantiated. California Code of Regulations, Title 22 is being cited on the attached LIC 9099D.

A copy of the report and Appeal Rights were provided.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Bennett Fong
LICENSING EVALUATOR NAME: Kelly Nguyen
LICENSING EVALUATOR SIGNATURE:

DATE: 09/03/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/03/2025
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
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
08/27/2025 and conducted by Evaluator Kelly Nguyen
COMPLAINT CONTROL NUMBER: 15-AS-20250827094527

FACILITY NAME:ELDRIDGE CARE HOMEFACILITY NUMBER:
019200682
ADMINISTRATOR:DIZON, MILLICENT RFACILITY TYPE:
735
ADDRESS:26601 ELDRIDGE AVENUETELEPHONE:
(510) 397-2056
CITY:HAYWARDSTATE: CAZIP CODE:
94544
CAPACITY:6CENSUS: 6DATE:
09/03/2025
UNANNOUNCEDTIME BEGAN:
02:20 PM
MET WITH:Millcent R DizonTIME COMPLETED:
04:30 PM
ALLEGATION(S):
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2
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8
9
Staff hit/kick resident
Staff yells at resident
Staff lock residents in rooms
INVESTIGATION FINDINGS:
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On 9/3/2025 , Licensing Program Analysts (LPAs) K. Nguyen and P. Manalo arrived unannounced to conduct and deliver finding on the above allegation and met with Administrator (ADM), Millcent R Dizon. LPAs explained to the purpose of the visit to ADM.

It was alleged that Staff hit/kick resident. LPAs conducted Client 1 (C1), Client (C2), Client 3 (C3) and interviewed Staff 1 (S1), Staff 2 (S2), and Staff 3 (S3) all stated they did not hit/kick any clients. C1 and C2 stated that staff did not hit or kick C1 or C2 nor withness any staff hit or kick anyone.

Report contiunes on LIC 9099c...
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Bennett Fong
LICENSING EVALUATOR NAME: Kelly Nguyen
LICENSING EVALUATOR SIGNATURE:

DATE: 09/03/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/03/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 2 of 4
Control Number 15-AS-20250827094527
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: 09/03/2025
NARRATIVE
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It was alleged that staff yells at resident. LPAs conducted Client 1 (C1), Client (C2), Client 3 (C3) and interviewed Staff 1 (S1), Staff 2 (S2), and Staff 3 (S3) all stated they did not yells at any clients. C1 and C2 stated that staff did not yell at C1 or C2 nor withness any staff yell at anyone.


It was alleged that staff locked resident in rooms. LPAs conducted Client 1 (C1), Client (C2), Client 3 (C3) and interviewed Staff 1 (S1), Staff 2 (S2), and Staff 3 (S3) all stated they did not knocked any clients. All clients have the right and have their individuals keys to their room. C1 and C2 stated that staff did not lock C1 and C2 nor witness any staff lock anyone in their room. C1 and C2 stated everyone have their own keys.


Based on interviews conducted, the above allegations are unsubstantiated.
Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegations are unsubstantiated.

There are no deficiencies issued. A copy of this report was provided to the Administrator.
SUPERVISORS NAME: Bennett Fong
LICENSING EVALUATOR NAME: Kelly Nguyen
LICENSING EVALUATOR SIGNATURE:

DATE: 09/03/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/03/2025
LIC9099 (FAS) - (06/04)
Page: 3 of 4
Control Number 15-AS-20250827094527
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
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/03/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
09/17/2025
Section Cited
CCR
80087(a)(1)
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80087(a)(1) Buildings and Grounds
(1) The licensee shall take measures to keep the facility free of flies and other insects.

This requirement is not met as evidenced by:
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The Administrator agrees to submit proof of pest control receipt and/or plan to CCLD by POC date.
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Based on interviews, the licensee did not comply with the section cited above by having cockroaches in the facility which poses 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.
SUPERVISORS NAME: Bennett Fong
LICENSING EVALUATOR NAME: Kelly Nguyen
LICENSING EVALUATOR SIGNATURE:

DATE: 09/03/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/03/2025
LIC9099 (FAS) - (06/04)
Page: 4 of 4