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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 019201495
Report Date: 07/09/2026
Date Signed: 07/09/2026 04:56:21 PM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
OAKLAND ASC, 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
06/30/2026 and conducted by Evaluator Patricia Manalo
COMPLAINT CONTROL NUMBER: 15-AS-20260630120228
FACILITY NAME:LINCOLN VILLAFACILITY NUMBER:
019201495
ADMINISTRATOR:DIVINA FERNANDEZFACILITY TYPE:
740
ADDRESS:41040 LINCOLN STREETTELEPHONE:
(510) 656-4373
CITY:FREMONTSTATE: CAZIP CODE:
94538
CAPACITY:80CENSUS: 79DATE:
07/09/2026
UNANNOUNCEDTIME BEGAN:
12:35 PM
MET WITH:Divina Fernandez, Administrator TIME COMPLETED:
05:15 PM
ALLEGATION(S):
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Staff are not ensuring that residents are accorded privacy in their rooms
INVESTIGATION FINDINGS:
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On 07/09/2026 at 12:35 PM, Licensing Program Analyst (LPA) P. Manalo conducted an initial 10-day complaint visit and delivered the findings on the above allegation. LPA met with Administrator, Divina Fernadez and explained the purpose of the visit.

During the course of investigation, LPA interviewed 7 residents and 3 staff members. LPA reviewed and obtained the following documents including but not limited to Resident Roster, Personnel Report (LIC500), Client/ Resident Personal Property and Valuables (LIC621), Admission Agreement, House Rules, and Safeguard Personal Property Policy.

Allegation: Staff are not ensuring that residents are accorded privacy in their rooms

Continue to LIC9099-C...
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Yvonne Flores-Larios
LICENSING EVALUATOR NAME: Patricia Manalo
LICENSING EVALUATOR SIGNATURE:

DATE: 07/09/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/09/2026
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 5
Control Number 15-AS-20260630120228
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
OAKLAND ASC, 1515 CLAY STREET, STE. 310
OAKLAND, CA 94612
FACILITY NAME: LINCOLN VILLA
FACILITY NUMBER: 019201495
VISIT DATE: 07/09/2026
NARRATIVE
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Continued from LIC9099...

It was alleged that staff are not ensuring that residents are accorded privacy in their rooms. Interview with R1 stated that on multiple occasions, other residents have walked in R1’s room and those residents are not R1’s roommate. Interview with 6 of 7 residents all indicated that they have observed other residents walk in their room and they were not their roommates. Interview with 2 of 3 staff members also stated that there are residents who wander in other residents’ rooms due to their medical diagnosis.

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, Division 6, Chapter 8), is being cited on the attached LIC 9099D.

Exit interview was conducted with Administrator.

A copy of this report and Appeal Rights was provided.
SUPERVISORS NAME: Yvonne Flores-Larios
LICENSING EVALUATOR NAME: Patricia Manalo
LICENSING EVALUATOR SIGNATURE:

DATE: 07/09/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/09/2026
LIC9099 (FAS) - (06/04)
Page: 2 of 5
Control Number 15-AS-20260630120228
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
OAKLAND ASC, 1515 CLAY STREET, STE. 310
OAKLAND, CA 94612

FACILITY NAME: LINCOLN VILLA
FACILITY NUMBER: 019201495
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/09/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
07/23/2026
Section Cited
CCR
87468.2(a)(1)
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87468.2(a)(1) Additional Personal Rights of Residents in Privately Operated Facilities
(1)To have a reasonable level of personal privacy in accommodations, medical treatment, personal care...

This requirement is not met as evidenced by:
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Administrator agrees to change residents' doors with a lock so that only the residents residing in that room and staff members have access. In addition, facility staff will coordinate with the resident and residents' responsible party of the new locking mechanism for their rooms. Proof of correction will be sent to CCLD.
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Based on interviews, the licensee did not comply with the section cited above when 6 of 7 residents all stated that other residents aside from their roommate will wander in their room which poses a potential safety and personal rights risk to residents 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.
SUPERVISOR'S NAME: Yvonne Flores-Larios
LICENSING EVALUATOR NAME: Patricia Manalo
LICENSING EVALUATOR SIGNATURE:

DATE: 07/09/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/09/2026
LIC9099 (FAS) - (06/04)
Page: 3 of 5
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
OAKLAND ASC, 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
06/30/2026 and conducted by Evaluator Patricia Manalo
COMPLAINT CONTROL NUMBER: 15-AS-20260630120228

FACILITY NAME:LINCOLN VILLAFACILITY NUMBER:
019201495
ADMINISTRATOR:DIVINA FERNANDEZFACILITY TYPE:
740
ADDRESS:41040 LINCOLN STREETTELEPHONE:
(510) 656-4373
CITY:FREMONTSTATE:CAZIP CODE:
94538
CAPACITY:80CENSUS: 79DATE:
07/09/2026
UNANNOUNCEDTIME BEGAN:
12:35 PM
MET WITH:Divina Fernandez, Administrator TIME COMPLETED:
05:15 PM
ALLEGATION(S):
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9
Staff do not safeguard resident's personal belongings
INVESTIGATION FINDINGS:
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On 07/09/2026 at 12:35 PM, Licensing Program Analyst (LPA) P. Manalo conducted an initial 10-day complaint visit and delivered the findings on the above allegation. LPA met with Administrator, Divina Fernadez and explained the purpose of the visit.

During the course of investigation, LPA interviewed 7 residents and 3 staff members. LPA reviewed and obtained the following documents including but not limited to Resident Roster, Personnel Report (LIC500), Client/ Resident Personal Property and Valuables (LIC621), Admission Agreement, House Rules, and Safeguard Personal Property Policy.

Continue to LIC9099-C...
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Yvonne Flores-Larios
LICENSING EVALUATOR NAME: Patricia Manalo
LICENSING EVALUATOR SIGNATURE:

DATE: 07/09/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/09/2026
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 4 of 5
Control Number 15-AS-20260630120228
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
OAKLAND ASC, 1515 CLAY STREET, STE. 310
OAKLAND, CA 94612
FACILITY NAME: LINCOLN VILLA
FACILITY NUMBER: 019201495
VISIT DATE: 07/09/2026
NARRATIVE
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Continued from LIC9099…

Allegation: Staff do not safeguard resident's personal belongings.

It was alleged that staff do not safeguard resident's personal belongings. Interview with R1 stated that there are some items in R1’s room that have been missing such as toiletries and food items. Interview with 5 other residents indicated that some of their personal belongings have been missing before. However, LPA conducted record review and it showed that residents' document of Client/ Resident Personal Property and Valuables (LIC621) indicated that they do not have items listed on it for the facility to safeguard.

Based on interviews and record review conducted, the above allegation that staff do not safeguard resident’s personal belongings is unsubstantiated. 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 allegations are unsubstantiated.

There is no deficiency noted.

Exit interview was conducted with Administrator, and a copy of this report was provided.
SUPERVISORS NAME: Yvonne Flores-Larios
LICENSING EVALUATOR NAME: Patricia Manalo
LICENSING EVALUATOR SIGNATURE:

DATE: 07/09/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/09/2026
LIC9099 (FAS) - (06/04)
Page: 5 of 5