075600975-2-7-2023-15-AS-KHOS-CQJPLS-20230403112512

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 075600975
Report Date: 02/07/2023
Date Signed: 02/07/2023 07:50:41 PM

Substantiated

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
02/07/2023 and conducted by Evaluator James Sampair

PUBLIC

COMPLAINT CONTROL NUMBER: 15-AS-20230207103817

FACILITY NAME:	TENDER TOUCH RESIDENTIAL CARE HOME II		FACILITY NUMBER:	075600975
ADMINISTRATOR:	ESTRELLITA S. CRUZ		FACILITY TYPE:	740
ADDRESS:	2053 DORSCH ROAD		TELEPHONE:	(925) 947-1421
CITY:	WALNUT CREEK	STATE: CA	ZIP CODE:	94598
CAPACITY:	6	CENSUS: 6	DATE:	02/07/2023
		UNANNOUNCED	TIME BEGAN:	03:00 PM
MET WITH:	Administrator Fe Dimaano and Owner Claro Villanueva		TIME COMPLETED:	08:00 PM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

1. Licensee and staff are not ensuring that changes in resident's medical condition were brought to the attention of responsible person.
2. Licensee and staff are not ensuring that the care is being provided to meet the needs of the resident.
3. Licensee not answering communication from the resident’s representatives appropriately.

INVESTIGATION FINDINGS:

1
2
3
4
5
6
7
8
9
10
11
12
13

On 02/07/2023, Licensing Program Analyst (LPA) J. Sampair arrived unannounced at 3:00PM to conduct a complaint investigation of the allegations above concerning the care of resident R1. The LPA met with Fe Dimaano and Claro Villanueva.

During the investigation, the LPA conducted interviews of 3 staff members and 4 witnesses. The LPA also reviewed documentation concerning R1’s care and communications with R1’s responsible parties (RPs).

Based on the records reviewed and the interviews conducted, the preponderance of evidence standard has been met; therefore, the above allegations are found to be SUBSTANTIATED.

Three (3) citations were issued (refer to LIC 9099D).

Exit interview conducted and copy of this report provided via email.

Substantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Harpreet Humpal	TELEPHONE: (510) 285-3928
LICENSING EVALUATOR NAME: James Sampair	TELEPHONE: (510) 286-4201
LICENSING EVALUATOR SIGNATURE:	DATE: 02/07/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/07/2023

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 4

Control Number 15-AS-20230207103817

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: TENDER TOUCH RESIDENTIAL CARE HOME II	FACILITY NUMBER: 075600975
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 02/07/2023

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 02/15/2023 Section Cited CCR 87466	1 2 3 4 5 6 7	The licensee shall ensure that … When changes such as … a physical health condition are observed, the licensee shall ensure that such changes are documented and brought to the attention of … the resident's responsible person. This requirement is not met as evidenced by:	1 2 3 4 5 6 7	Administrator to create a daily log and train staff on its use to record communications with residents’ family, record physical and mental status, and communications with health care providers.
	8 9 10 11 12 13 14	Based on interviews and observations, the licencee did not comply with the section cited above, which poses a potential health and safety or personal rights risk to persons in care.	8 9 10 11 12 13 14
Type B 02/15/2023 Section Cited CCR 87468.1(a)(9)	1 2 3 4 5 6 7	Personal Rights of Residents in all Facilities (9) To have communications to the licensee from their representatives answered promptly and appropriately. This requirement is not met as evidenced by:	1 2 3 4 5 6 7	Fe will send documentation to LPA to be administrator and to receive confirmation that she has been appointed administrator.
	8 9 10 11 12 13 14	Based on interviews, the licencee did not comply with the section cited above, which poses a potential health and safety or personal rights risk 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.

SUPERVISOR'S NAME: Harpreet Humpal	TELEPHONE: (510) 285-3928
LICENSING EVALUATOR NAME: James Sampair	TELEPHONE: (510) 286-4201
LICENSING EVALUATOR SIGNATURE:	DATE: 02/07/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/07/2023

LIC9099 (FAS) - (06/04)

Page: 3 of 4

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
02/07/2023 and conducted by Evaluator James Sampair

PUBLIC

COMPLAINT CONTROL NUMBER: 15-AS-20230207103817

FACILITY NAME:	TENDER TOUCH RESIDENTIAL CARE HOME II		FACILITY NUMBER:	075600975
ADMINISTRATOR:	ESTRELLITA S. CRUZ		FACILITY TYPE:	740
ADDRESS:	2053 DORSCH ROAD		TELEPHONE:	(925) 947-1421
CITY:	WALNUT CREEK	STATE: CA	ZIP CODE:	94598
CAPACITY:	6	CENSUS: 6	DATE:	02/07/2023
		UNANNOUNCED	TIME BEGAN:	03:00 PM
MET WITH:	Administrator Fe Dimaano and Owner Claro Villanueva		TIME COMPLETED:	08:00 PM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

1. Licensee and staff transferred resident involuntarily.
2. Licensee and staff did not adhere to 60-day notice for change in rent.

INVESTIGATION FINDINGS:

1
2
3
4
5
6
7
8
9
10
11
12
13

On 02/07/2023, Licensing Program Analyst (LPA) J. Sampair arrived unannounced at 3:00PM to conduct a complaint investigation of the allegations above concerning the care of resident R1. The LPA met with Fe Dimaano and Claro Villanueva.

During the investigation, the LPA conducted interviews of 3 staff members and 4 witnesses. The LPA also reviewed documentation concerning R1’s care and communications with R1’s responsible parties (RPs).

Based on the records reviewed and interviews conducted, although the allegation may have happened, the preponderance of evidence does not prove it; therefore, the above allegations are found to be UNSUBSTANTIATED.

Exit interview conducted and copy of this report provided via email.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Harpreet Humpal	TELEPHONE: (510) 285-3928
LICENSING EVALUATOR NAME: James Sampair	TELEPHONE: (510) 286-4201
LICENSING EVALUATOR SIGNATURE:	DATE: 02/07/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/07/2023

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

Page: 2 of 4

Control Number 15-AS-20230207103817

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: TENDER TOUCH RESIDENTIAL CARE HOME II	FACILITY NUMBER: 075600975
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 02/07/2023

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type A 02/09/2023 Section Cited CCR 87468.2(a)(4)	1 2 3 4 5 6 7	(a) ... shall have all of the following personal rights: (4) To care, supervision, and services that meet their individual needs and are delivered by staff that are sufficient in numbers, qualifications, and competency to meet their needs. This requirement is not met as evidenced by:	1 2 3 4 5 6 7	Administrator will obtain plan of care, follow its execution to the letter, send copy to LPA and share with R1’s responsible parties by 2/9/23
	8 9 10 11 12 13 14	Based on interviews and record reviews, the licencee did not comply with the section cited above, which poses an immediate Health, Safety or Personal Rights risk to residents in care.	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: Harpreet Humpal	TELEPHONE: (510) 285-3928
LICENSING EVALUATOR NAME: James Sampair	TELEPHONE: (510) 286-4201
LICENSING EVALUATOR SIGNATURE:	DATE: 02/07/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/07/2023

LIC9099 (FAS) - (06/04)

Page: 4 of 4