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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 019201069
Report Date: 05/09/2023
Date Signed: 05/09/2023 06:51:55 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
12/13/2021 and conducted by Evaluator Alicia Delmundo
COMPLAINT CONTROL NUMBER: 15-AS-20211213151630
FACILITY NAME:GENTLE HEART CARE SERVICES INCFACILITY NUMBER:
019201069
ADMINISTRATOR:SPENCER, ALANNAFACILITY TYPE:
735
ADDRESS:1559 D STREETTELEPHONE:
(510) 342-6740
CITY:HAYWARDSTATE: CAZIP CODE:
94541
CAPACITY:6CENSUS: 5DATE:
05/09/2023
UNANNOUNCEDTIME BEGAN:
06:30 PM
MET WITH:Staff, Sameer AzizTIME COMPLETED:
07:00 PM
ALLEGATION(S):
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Facility is not allowing resident (R1) to accept phone calls.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Delmundo arrived unannounced to deliver the findings on the above allegation. LPA met with Sameer Aziz, staff, and informed the reason for visit.

It was alleged that facility is not allowing resident (R1) to accept phone calls. It was further alleged that every few days, calls were made to check if R1 was at the facility so FM can visit, but facility refused to provide information, and was told to call R1’s conservator (RC), but RC does not give any information.



........continued on 9099C
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Bennett Fong
LICENSING EVALUATOR NAME: Alicia Delmundo
LICENSING EVALUATOR SIGNATURE:

DATE: 05/09/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/09/2023
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-20211213151630
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: GENTLE HEART CARE SERVICES INC
FACILITY NUMBER: 019201069
VISIT DATE: 05/09/2023
NARRATIVE
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During the course of investigation, LPA reviewed and obtained copies of conservatorship and other court documents. LPA interviewed FM who indicated that all except 1 staff did not answer FM, and the rest of the staff said to contact R1’s conservator (RC). Staff (S1) and administrator were interviewed. S1 stated she was instructed by the administrator not to provide any information to FM about R1, and to tell FM to contact the conservator which was confirmed by LPA with the administrator. The administrator indicated that R1 is conserved, and was told by the conservator not to provide any information to FM.

LPA interviewed RC who indicated that FM is not allowed to contact R1. Review of court documents revealed the conservator was granted the authority to enforce R1's right to receive, deny. and/or limit visitation, telephone calls, personal mail, and any other contact including FM. LPA was not able to interview R1.

Based on all information gathered, and LPA unable to interview R1, the allegation is closed as unsubstantiated. A finding that the complaint is unsubstantiated means that although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violation occurred.



No deficiency cited.

Exit interview conducted and copy of this report provided to Sameer Aziz.
SUPERVISORS NAME: Bennett Fong
LICENSING EVALUATOR NAME: Alicia Delmundo
LICENSING EVALUATOR SIGNATURE:

DATE: 05/09/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/09/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 2