019201069-3-26-2025-15-AS-KHOS-DFHHPW-20250407062301

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 019201069
Report Date: 03/26/2025
Date Signed: 03/26/2025 01:13:35 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
11/20/2024 and conducted by Evaluator Daisy Panlilio

COMPLAINT CONTROL NUMBER: 15-AS-20241120113639

FACILITY NAME:	GENTLE HEART CARE SERVICES INC		FACILITY NUMBER:	019201069
ADMINISTRATOR:	SPENCER, ALANNA		FACILITY TYPE:	735
ADDRESS:	1559 D STREET		TELEPHONE:	(510) 397-4813
CITY:	HAYWARD	STATE: CA	ZIP CODE:	94541
CAPACITY:	6	CENSUS: 6	DATE:	03/26/2025
		UNANNOUNCED	TIME BEGAN:	12:30 PM
MET WITH:	Sameer Aziz, Staff Alanna Spencer, ADM		TIME COMPLETED:	02:00 PM

ALLEGATION(S):

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Resident is using illegal substance(s) while in care
Licensee does not ensure that the facility maintains an adequate food supply
Licensee does not ensure that facility is kept clean
Licensee does not ensure that residents are provided with activities while in care
Staff are not providing adequate care and supervision to residents in care
Facility is in disrepair

INVESTIGATION FINDINGS:

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On 03/26/25 at 12:30PM, Licensing Program Analyst (LPA) D Panlilio conducted a subsequent visit, met with staff (S1) and spoke to administrator (ADM) on the phone who authorized S1 to act on her behalf and sign the reports. LPA explained the purpose of the visit with staff (S1, ADM) and delivered the findings of above allegations.

During investigation, the department obtained the following documents from administrator – Personnel record (LIC500), Clients’ roster, physician's report, Face Sheets, Appraisal/Needs & Services plans, incident reports. Health & safety check conducted see LIC 809 dated 11/21/24. Continued on next page, LIC 9099-C

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Bennett Fong
LICENSING EVALUATOR NAME: Daisy Panlilio
LICENSING EVALUATOR SIGNATURE:	DATE: 03/26/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/26/2025

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

Control Number 15-AS-20241120113639

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: 03/26/2025

NARRATIVE

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Allegation: Resident is using illegal substance(s) while in care
Investigation Finding: Unsubstantiated
During investigation, the department conducted interviews of clients (C1, C2, C3, C4, C5, C6) and facility staff (S1, S2). On 11/21/24, LPA K Nguyen interviewed clients (C2, C3, C4) who stated that they did not see any client engage in drug use inside the facility. On 12/16/24, the department interviewed all six clients (C1, C2, C3, C4, C5, C6). C4 stated she observed C1 use “Metamphetamine” drugs outside the facility but never witnessed C1 engage in substance abuse while in care and did not see any illegal substances at the facility. LPA K Nguyen also interviewed staff (S1) who stated that C1 uses illegal drugs but never inside the facility. Although the allegation may have happened or are valid, there is not a preponderance of the evidence to prove that the alleged violation occurred. Therefore, the allegation that resident is using illegal substance while in care is unsubstantiated.

Allegation: Licensee does not ensure that the facility maintains an adequate food supply
Investigation Finding: Unsubstantiated
During investigation, LPA observed 2-day supply of perishables and 7-day supply of non-perishable food during visit on 11/21/24. LPA observed vegan patties, various meats (hamburger, chicken, pork), pizza, fresh vegetables, milk, juice, fruits stored in the refrigerator and freezer. LPA interviewed random clients (C2, C3, C4) who stated that they get adequate portions of food 3 times a day with snacks/drinks available in between. Clients also stated that they are given choices of other food if they do not like what they are given. Although the allegation may have happened or are valid, there is not a preponderance of the evidence to prove that the alleged violation occurred. Therefore, the allegation licensee does not ensure that facility maintains an adequate food supply is unsubstantiated.

Continued on next page, LIC 9099C pg2

SUPERVISORS NAME: Bennett Fong
LICENSING EVALUATOR NAME: Daisy Panlilio
LICENSING EVALUATOR SIGNATURE:	DATE: 03/26/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/26/2025

LIC9099 (FAS) - (06/04)

Page: 2 of 4

Control Number 15-AS-20241120113639

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: 03/26/2025

NARRATIVE

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Allegation: Licensee does not ensure that the facility is kept clean
Investigation Finding: Unsubstantiated
During investigation, LPA observed facility to be clean and odor free during visit on 11/21/24. LPA interviewed staff (S1) who stated that they clean and disinfect the facility daily. LPA also interviewed random clients (C2, C3, C4) who confirmed that staff clean the facility daily. Although the allegation /may have happened or are valid, there is not a preponderance of the evidence to prove that the alleged violation occurred. Therefore, the allegation that licensee does not ensure that facility is kept clean is unsubstantiated.

Allegation: Licensee does not ensure that residents are provided with activities while in care
Investigation Finding: Unsubstantiated
During investigation, LPA observed random clients (C2, C3, C4) walking around independently during visit on 11/21/24. Clients told LPA they prefer going out on their own to spend time with friends & family, go shopping, visit parks & theaters and eat at their favorite restaurants. Clients also stated that other clients are independent and have the same preference of scheduling their own activities with friends, family and community-based programs. LPA interviewed staff (S1) who stated that all 6 clients are ambulatory, require minimal assistance, attend their regular adult day programs/ community-based activities independently. Staff stated that they offer all clients other activities such as celebrating birthdays, community outings in parks and restaurants, watching movies at the theater and walking around the neighborhood. Although the allegation may have happened or are valid, there is not a preponderance of the evidence to prove that the alleged violation occurred. Therefore, the allegation that licensee does not ensure that residents are provided with activities while in care is unsubstantiated.

Continued on next page, LIC 9099C pg 3

SUPERVISORS NAME: Bennett Fong
LICENSING EVALUATOR NAME: Daisy Panlilio
LICENSING EVALUATOR SIGNATURE:	DATE: 03/26/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/26/2025

LIC9099 (FAS) - (06/04)

Page: 3 of 4

Control Number 15-AS-20241120113639

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: 03/26/2025

NARRATIVE

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Allegation: Staff are not providing adequate care and supervision to residents in care
Investigation Finding: Unsubstantiated
During investigation, LPA observed random clients (C2, C3, C4) ambulatory and high functioning during visit on 11/21/24. Staff (S1) confirmed with LPA that all six clients are ambulatory and able to leave the facility unassisted whenever they attend their community based & adult day programs, go on outings or visit friends and family. Staff stated that they never witnessed any client engage in substance abuse while in care and did not see any illegal substances at the facility. On 12/16/24, the department interviewed all six clients (C1, C2, C3, C4, C5, C6) who stated that they require minimal assistance from staff and that they did not have any concerns living at the facility, that staff treat them well. Although the allegation may have happened or are valid, there is not a preponderance of the evidence to prove that the alleged violation occurred. Therefore, the allegation that staff are not providing adequate care and supervision to residents in care is unsubstantiated.

Allegation: Facility is in disrepair
Investigation Finding: Unsubstantiated
During investigation, LPA observed the heat working during visit on 11/21/24 with thermostat reading at 70 deg F. LPA interviewed random clients (C2, C3, C4) who confirmed that staff provide all six clients with portable heaters and blankets to keep them warm during winter months. LPA interviewed staff (S1) who stated that they assist clients with additional blankets and heaters when needed since the house is old and does not retain heat. Although the allegation may have happened or are valid, there is not a preponderance of the evidence to prove that the alleged violation occurred. Therefore, the allegation that facility is in disrepair is unsubstantiated.

No deficiency cited during visit.

Exit interview conducted and a copy of this report provided.

SUPERVISORS NAME: Bennett Fong
LICENSING EVALUATOR NAME: Daisy Panlilio
LICENSING EVALUATOR SIGNATURE:	DATE: 03/26/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/26/2025

LIC9099 (FAS) - (06/04)

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