075600632-6-6-2024-15-AS-BFOG-D66UPL-20240612154544

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 075600632
Report Date: 06/06/2024
Date Signed: 06/06/2024 08:24:18 PM

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
05/31/2024 and conducted by Evaluator Lori Alexander-Washington

PUBLIC

COMPLAINT CONTROL NUMBER: 15-AS-20240531112924

FACILITY NAME:	TENDER TOUCH RESIDENTIAL CARE HOME		FACILITY NUMBER:	075600632
ADMINISTRATOR:	CRUZ, ESTRELLITA S.		FACILITY TYPE:	740
ADDRESS:	58 MIDHILL ROAD		TELEPHONE:	(925) 228-5683
CITY:	MARTINEZ	STATE: CA	ZIP CODE:	94553
CAPACITY:	6	CENSUS: 6	DATE:	06/06/2024
		UNANNOUNCED	TIME BEGAN:	03:15 PM
MET WITH:	Claro Villanueva, Staff		TIME COMPLETED:	08:45 PM

ALLEGATION(S):

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Staff did not issue resident's responisble party a refund.

INVESTIGATION FINDINGS:

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On 06/06/2024 at 3:15 PM, Licensing Program Analyst (LPA) L. Alexander conducted an unannounced complaint visit, met with staff, gathered information and delivered investigation finding of above allegation. LPA explained the purpose of the visit with staff.

During investigation, following documents reviewed: Admission Agreement, Physician Reports and monthly invoices.

Continued on next page, LIC 9099-C

Substantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Bennett Fong	TELEPHONE: (510) 725-7919
LICENSING EVALUATOR NAME: Lori Alexander-Washington	TELEPHONE: (510) 285-3934
LICENSING EVALUATOR SIGNATURE:	DATE: 06/06/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/06/2024

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 3

Control Number 15-AS-20240531112924

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: TENDER TOUCH RESIDENTIAL CARE HOME	FACILITY NUMBER: 075600632
	VISIT DATE: 06/06/2024

NARRATIVE

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LIC9099-C

Allegation: Staff did not issue resident's responsible party a refund.
Investigation Finding: Substantiated

During investigation, LPA interviewed (Staff 1) S1 who stated that the resident (R1) was first admitted at the facility on 02/06/23. S1 confirmed with LPA that R1 paid $6,000 1st month rent on 02/06/23, $6,000 last month rent on 02/14/23 and $2,000 security deposit for damages on 03/06/23. S1 stated that per S2, the security deposit was for damages due to the resident urinating on the hardwood floors in their bedroom and facility. R1 moved out the facility on 04/01/24. Per RP, R1 should have a refund of $9,380.82. The calculations is prorated from April 2nd through April 8th, 2024 which is $1,380.82. S1 stated that they will pay the refund back to R1.

Based on the department’s observations and interviews which were conducted and record review(s), the preponderance of evidence standard has been met, therefore the above allegation that facility did not issue a refund according to the resident's admission agreement was found to be substantiated.

Deficiency is cited per Title 22 California Code of Regulations and listed on LIC9099D. Failure to submit proof of corrections (POC) by plan of correction due dates and/or any repeat deficiencies within a 12-month period may result in civil penalties.

SUPERVISOR'S NAME: Bennett Fong	TELEPHONE: (510) 725-7919
LICENSING EVALUATOR NAME: Lori Alexander-Washington	TELEPHONE: (510) 285-3934
LICENSING EVALUATOR SIGNATURE:	DATE: 06/06/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/06/2024

LIC9099 (FAS) - (06/04)

Page: 2 of 3

Control Number 15-AS-20240531112924

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: TENDER TOUCH RESIDENTIAL CARE HOME	FACILITY NUMBER: 075600632
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 06/06/2024

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 06/06/2024 Section Cited CCR 87507(C)(1)	1 2 3 4 5 6 7	87507 Admission Agreements (C) Any fee that is charged prior to or after admission, shall be clearly specified..1. If a licensee charges a preadmission fee, the licensee must provide the applicant or his or her representative with a written general statement describing all costs associated with the preadmission fee charges and stating that the preadmission fee is refundable, and describing conditions for the refund.	1 2 3 4 5 6 7	Licensee agreed to refund R1 back $9,380.82. Licensee paid the refund back to R1's POA during visit. Deficiency cleared.
	8 9 10 11 12 13 14	This requirement was not met as evidenced by facility staff did not issue a refund according to the resident’s admission agreement which is a violation of Title 22 Section 87507.	8 9 10 11 12 13 14
	1 2 3 4 5 6 7		1 2 3 4 5 6 7
	1 2 3 4 5 6 7		1 2 3 4 5 6 7

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: Bennett Fong	TELEPHONE: (510) 725-7919
LICENSING EVALUATOR NAME: Lori Alexander-Washington	TELEPHONE: (510) 285-3934
LICENSING EVALUATOR SIGNATURE:	DATE: 06/06/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/06/2024

LIC9099 (FAS) - (06/04)

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