019200685-7-1-2024-15-AS-BFOG-D9VTRE-20241009145722

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 019200685
Report Date: 07/01/2024
Date Signed: 07/01/2024 02:16:15 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
06/25/2024 and conducted by Evaluator Kelly Nguyen

COMPLAINT CONTROL NUMBER: 15-AS-20240625113906

FACILITY NAME:	CAREFIELD CASTRO VALLEY		FACILITY NUMBER:	019200685
ADMINISTRATOR:	PARVEEN SINGH		FACILITY TYPE:	740
ADDRESS:	19960 SANTA MARIA AVE		TELEPHONE:	(510) 582-2765
CITY:	CASTRO VALLEY	STATE: CA	ZIP CODE:	94546
CAPACITY:	116	CENSUS: 69	DATE:	07/01/2024
		UNANNOUNCED	TIME BEGAN:	12:40 PM
MET WITH:	Parveen Singh, Senior Executive Director		TIME COMPLETED:	02:35 PM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Staff do not ensure facility is maintained clean
Staff do not ensure facility is maintained odorless

INVESTIGATION FINDINGS:

1
2
3
4
5
6
7
8
9
10
11
12
13

On 7/1/24 Licensing Program Analyst (LPA) K. Nguyen arrived unannounced to conduct a complaint investigation for the above allegation starting at 12:40pm. LPA met with Parveen Singh Senior Executive Director and explained the purpose of the visit.

Allegation: Staff do not ensure facility is maintained clean: Unsubstantiated

During visit LPA interviewed Senior Executive Director, and three other care staff. LPA took a tour of the facility including but not limited to dining area, assisted living and memory care unit. LPA tour R1, R2, R3, R4, R5, and R6 room in memory care unit. LPA observed facility is clean and clear of obstruction. LPA observed that there is no furniture that is in disrepair.

Report continued on LIC 9099C...

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Bennett Fong	TELEPHONE: (510) 725-7919
LICENSING EVALUATOR NAME: Kelly Nguyen	TELEPHONE: (510) 915-8702
LICENSING EVALUATOR SIGNATURE:	DATE: 07/01/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/01/2024

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-20240625113906

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: CAREFIELD CASTRO VALLEY	FACILITY NUMBER: 019200685
	VISIT DATE: 07/01/2024

NARRATIVE

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32

Allegation: Staff do not ensure facility is maintained odorless: Unsubstantiated

LPA observed in memory care unit there is no odor smell. LPA observed in R1, R2, R3, R4, R5, and R6 room are kept clean and odor free. LPA interview S1, S2, and S3 stated that there has not been any odor that they notice in the building or in any resident’s room.

Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is UNSUBSTANTIATED.

Exit interview conducted and a copy of this report provided via email.

SUPERVISOR'S NAME: Bennett Fong	TELEPHONE: (510) 725-7919
LICENSING EVALUATOR NAME: Kelly Nguyen	TELEPHONE: (510) 915-8702
LICENSING EVALUATOR SIGNATURE:	DATE: 07/01/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/01/2024

LIC9099 (FAS) - (06/04)

Page: 2 of 2