<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 071440106
Report Date: 09/30/2025
Date Signed: 09/30/2025 11:40:49 AM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
E BAY DELTA AC/SC, 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
08/28/2025 and conducted by Evaluator Lori Alexander-Washington
PUBLIC
COMPLAINT CONTROL NUMBER: 15-AS-20250828161548
FACILITY NAME:CONCORD HOUSEFACILITY NUMBER:
071440106
ADMINISTRATOR:LEYBA, MARY ANNFACILITY TYPE:
735
ADDRESS:2301 MT. DIABLO ST.TELEPHONE:
(925) 825-4423
CITY:CONCORDSTATE: CAZIP CODE:
94520
CAPACITY:16CENSUS: 12DATE:
09/30/2025
UNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Sister Mary Ann Leyba, AdministratorTIME COMPLETED:
12:00 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Resident was required to participate in activities
Facility is providing insuffient food service to resident
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
On 09/30/2025 at 10:00 AM, Licensing Program Analyst (LPA) L. Alexander delivered the complaint findings investigated by LPA L. Holmes (LPA1). LPA met with and explained the purpose of the visit to Sister Mary Ann Leyba, Administrator.

LPA1 toured the facility, requested and reviewed the following documents: LIC500, Resident Roster, House Rules, Snack Log, and Menu/Sample Menu. LPA1 interviewed Witnesses (W1 & W2), Clients (C1, C2), and reviewed Clients Serious Incident Reports (SIRs).


LIC9099-C Continued...
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Bennett Fong
LICENSING EVALUATOR NAME: Lori Alexander-Washington
LICENSING EVALUATOR SIGNATURE:

DATE: 09/30/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/30/2025
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 6
Control Number 15-AS-20250828161548
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
E BAY DELTA AC/SC, 1515 CLAY STREET, STE. 310
OAKLAND, CA 94612
FACILITY NAME: CONCORD HOUSE
FACILITY NUMBER: 071440106
VISIT DATE: 09/30/2025
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
LIC 9099-C (Page 2)

Allegation: Resident was required to participate in activities
Finding: SUBSTANTIATED

UIRs and interviews document W1, W2 , C1, C2, C4, and C5 expressing concerns about “Being in trouble” or not being able to attend “Snack Out” if they didn’t socialize with others, partake in chores, wanted additional money, wanted to leave unattended, shower other than evenings or nights, and/or talk on their phones in private. C1 stated that the phone closet was not private, a conversation could be heard, and that going outside or into the backyard alone was not an option; LPA observed the phone closet to be in a common area that appeared to be less private than their room. C1, C2, C4, and C5 all expressed concerns on different occasions about losing their privileges.

Allegation: Facility is providing insufficient food service to resident


Finding: SUBSTANTIATED

W1 and W2 advocated larger breakfasts, observed lunches from C1, C2 and C4 to be either small in portions with fruits, vegetables, and minimal, protein, fats and carbohydrates. C1 and C2 stated that they and other clients at the facility had to wait for the time that was allotted for snacks or dinner if they wanted more food; neither complained to S1 due to not knowing their personal rights to snacks outside of a designated time and reported the food as not being enough. LPA captures photos of the facility’s food supply. Although there was a sufficient amount of food, LPA did not observe a variety of prepared or unfrozen proteins, breads, pre-packaged meals, or left-overs that could be easily prepared or reheated by staff and clients.

LIC9099-C Continued...

SUPERVISORS NAME: Bennett Fong
LICENSING EVALUATOR NAME: Lori Alexander-Washington
LICENSING EVALUATOR SIGNATURE:

DATE: 09/30/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/30/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 6
Control Number 15-AS-20250828161548
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
E BAY DELTA AC/SC, 1515 CLAY STREET, STE. 310
OAKLAND, CA 94612
FACILITY NAME: CONCORD HOUSE
FACILITY NUMBER: 071440106
VISIT DATE: 09/30/2025
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
LIC9099-C (Page 3)

Based on LPA’s interviews, observations and records reviewed, the preponderance of evidence standard has been met; therefore, the above allegations are SUBSTANTIATED. Deficiencies are cited from Title 22 California Code of Regulations and listed on LIC9099D. Failure to submit proof of correction by plan of correction due date, and any repeat violations within a 12-month period may result in civil penalties.

Exit interview conducted, a copy of this report and appeal rights provided to Sister Mary Ann Leyba, Administrator.

SUPERVISORS NAME: Bennett Fong
LICENSING EVALUATOR NAME: Lori Alexander-Washington
LICENSING EVALUATOR SIGNATURE:

DATE: 09/30/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/30/2025
LIC9099 (FAS) - (06/04)
Page: 3 of 6
Control Number 15-AS-20250828161548
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
E BAY DELTA AC/SC, 1515 CLAY STREET, STE. 310
OAKLAND, CA 94612

FACILITY NAME: CONCORD HOUSE
FACILITY NUMBER: 071440106
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/30/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
10/14/2025
Section Cited
CCR
80072(3)
1
2
3
4
5
6
7
80072 Personal Rights
(3) To be free from corporal or unusual punishment, infliction of pain, humiliation, intimidation, ridicule, coercion, threat, mental abuse, or other actions of a punitive nature, including but not limited to: interference with the daily living functions, including eating, sleeping, or toileting; or withholding of shelter, clothing, medication or aids to physical functioning.

This requirement was not met as evidence by:
1
2
3
4
5
6
7
Administrator agreed to provide written notice of personal rights to the Client’s RP and CMs. Conduct in-service with staff and clients regarding Personal Rights regulations. Provide proof with signatures of staff and clients to CCLD by POC.
8
9
10
11
12
13
14
Based on interviews and records reviewed, the Licensee did not comply with the section cited above by not adhering to the clients’ personal rights which posed a health and safety issue to persons in care.
8
9
10
11
12
13
14
Type B
10/14/2025
Section Cited
CCR
80076(a)(4)
1
2
3
4
5
6
7
80076 Food Services
(a) In facilities providing meals to clients, the following shall apply:
( 4) Between meal nourishment or snacks shall be available for all clients unless limited by dietary restrictions prescribed by a physician.

This requirement was not met as evidence by:
1
2
3
4
5
6
7
Administrator agreed to advise staff and clients of their right to a variety of snacks upon request. Conduct in-service with staff and clients regarding regulations. Provide proof with signatures of staff and clients to CCLD by POC.
8
9
10
11
12
13
14
Based on interviews, observations and records reviewed, the Licensee did not comply with the section cited above by not addressing the requests for snack and larger lunches, which posed a health and safety issue to persons in care.
8
9
10
11
12
13
14
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISORS NAME: Bennett Fong
LICENSING EVALUATOR NAME: Lori Alexander-Washington
LICENSING EVALUATOR SIGNATURE:

DATE: 09/30/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/30/2025
LIC9099 (FAS) - (06/04)
Page: 4 of 6
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
E BAY DELTA AC/SC, 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
08/28/2025 and conducted by Evaluator Lori Alexander-Washington
PUBLIC
COMPLAINT CONTROL NUMBER: 15-AS-20250828161548

FACILITY NAME:CONCORD HOUSEFACILITY NUMBER:
071440106
ADMINISTRATOR:LEYBA, MARY ANNFACILITY TYPE:
735
ADDRESS:2301 MT. DIABLO ST.TELEPHONE:
(925) 825-4423
CITY:CONCORDSTATE: CAZIP CODE:
94520
CAPACITY:16CENSUS: 12DATE:
09/30/2025
UNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Sister Mary Ann Leyba, AdministratorTIME COMPLETED:
12:00 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Facility conducted a team meeting and resident family was not included or notified
Facility not providing snacks
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Allegation: Facility conducted a team meeting and resident family was not included or notified
Finding: UNSUBSTANTIATED

C1, C2, C4 or C5 had not requested or was declined in having their family involved in meetings, S1 stated that no one has asked to be in a team meeting. Annual IPPs are for Clients and all RP’s, it’s like a party and quarterly ones are with case managers, staff and clients that last shortly to discuss appts, goals, changes in medication.

Allegation: Facility not providing snacks
Finding: UNSUBSTANTIATED

LIC9099-C Continued...
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Bennett Fong
LICENSING EVALUATOR NAME: Lori Alexander-Washington
LICENSING EVALUATOR SIGNATURE:

DATE: 09/30/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/30/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 6 of 6
Control Number 15-AS-20250828161548
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
E BAY DELTA AC/SC, 1515 CLAY STREET, STE. 310
OAKLAND, CA 94612
FACILITY NAME: CONCORD HOUSE
FACILITY NUMBER: 071440106
VISIT DATE: 09/30/2025
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
LIC9099-C (Page 6)

LPA1 observed and captured photos of a 2-day supply of perishable and 7-day supply of non-perishables that included, but not limited to oranges, watermelon, apples, grapes, grapefruits, milk, eggs, cheese, yogurt, cold-cuts, oatmeal, popcorn and variety of canned goods that were fruits, vegetables and soup.

Based on LPA1’s interviews, observations and records reviewed, the preponderance of evidence standard has not been met; therefore, the above allegations are
UNSUBSTANTIATED.

Exit interview conducted and a copy of this report provided to Sister Mary Ann Leyba, Administrator.
SUPERVISORS NAME: Bennett Fong
LICENSING EVALUATOR NAME: Lori Alexander-Washington
LICENSING EVALUATOR SIGNATURE:

DATE: 09/30/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/30/2025
LIC9099 (FAS) - (06/04)
Page: 5 of 6