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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 019200853
Report Date: 07/01/2026
Date Signed: 07/01/2026 02:07:26 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
06/04/2026 and conducted by Evaluator Kelly Nguyen
COMPLAINT CONTROL NUMBER: 15-AS-20260604092717
FACILITY NAME:LIVERMORE CARE HOMEFACILITY NUMBER:
019200853
ADMINISTRATOR:SANDHU, SEEMAFACILITY TYPE:
740
ADDRESS:1542 PERIDOT DRTELEPHONE:
(510) 695-3017
CITY:LIVERMORESTATE: CAZIP CODE:
94550
CAPACITY:6CENSUS: 4DATE:
07/01/2026
UNANNOUNCEDTIME BEGAN:
12:45 PM
MET WITH:Hector Calan, Care Giver TIME COMPLETED:
02:30 PM
ALLEGATION(S):
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Staff left residents unattended
INVESTIGATION FINDINGS:
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On 07/01/2026 at 12:45 p.m., Licensing Program Analyst (LPA) K. Nguyen arrived unannounced to deliver findings for the allegation above. LPA met with care staff Hector Calan and informed him of the purpose of the visit. Mr. Hector notified Administrator (ADM) Madeena Siddiqi by telephone. LPA was unable to speak with ADM because LPA was informed that ADM is currently in the hospital and unable to communicate. ADM later communicated with LPA via text message, granting Mr. Hector permission to sign the report.

During the course of the investigation, LPA conducted interviews with the Administrator, Staff 1 (S1), Staff 2 (S2), residents R1, R2, R3, R4, and Witnesses 1 (W1), 3 (W3), and 4 (W4).

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

DATE: 07/01/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/01/2026
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-20260604092717
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: LIVERMORE CARE HOME
FACILITY NUMBER: 019200853
VISIT DATE: 07/01/2026
NARRATIVE
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It was alleged that staff left residents unattended. Based on interviews conducted with four residents (R1–R4) and two witnesses (W1–W3- W4), all stated: “They have no concern about residents being left unattended; there are always staff available to open the door”. The witnesses interviewed did not observe staff leaving residents without supervision. Residents (R1-R4) interviewed stated that “staff are always available to assist us, and don’t leave us unattended”. R3 stated that “staff don’t leave us unattended. They may be busy at times, but they are always attending to our needs”. R2 stated, “I have not been left unattended”.

Based on the interviews conducted with residents (R1-R4) and Witnesses (W1-W3-W4), the allegation that staff left residents unattended is unsubstantiated: although it may have occurred or be valid, there is insufficient evidence to prove it.

An exit interview was conducted, and a copy of this report was provided.
SUPERVISORS NAME: Bennett Fong
LICENSING EVALUATOR NAME: Kelly Nguyen
LICENSING EVALUATOR SIGNATURE:

DATE: 07/01/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/01/2026
LIC9099 (FAS) - (06/04)
Page: 2 of 2