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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 075601041
Report Date: 09/08/2025
Date Signed: 09/08/2025 05:53:03 PM

Unsubstantiated


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
06/19/2025 and conducted by Evaluator James Sampair
PUBLIC
COMPLAINT CONTROL NUMBER: 15-AS-20250619100905
FACILITY NAME:GINES RESIDENTIAL CARE HOME IIIFACILITY NUMBER:
075601041
ADMINISTRATOR:GINES, ERLINDAFACILITY TYPE:
740
ADDRESS:2565 STONE VALLEY ROADTELEPHONE:
(925) 743-1146
CITY:ALAMOSTATE: CAZIP CODE:
94507
CAPACITY:6CENSUS: 5DATE:
09/08/2025
UNANNOUNCEDTIME BEGAN:
03:30 PM
MET WITH:Administrator / Licensee Linda Gines and Administrator Elizabeth BoehmerTIME COMPLETED:
06:00 PM
ALLEGATION(S):
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Staff do not provide resident with a diet according to resident’s health needs.
INVESTIGATION FINDINGS:
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On 9/8/2025, at 3:30 PM, Licensing Program Analyst (LPA) James Sampair arrived unannounced at the facility to complete the investigation of the allegation above. Upon entry into the facility, the LPA identified himself and stated the purpose of the visit to Administrator / Licensee (ADM 1) Linda Gines and Administrator (ADM 2) Elizabeth Boehmer.

Over the course of the investigation, the LPA interviewed Resident R1, Witness W1, ADM 1, and ADM 2. The LPA reviewed R1's Physician's Report, Preplacement Appraisal, Care Plan, personalized diabetic menu for R1, Caregiver Notes, and photos of R1's food refusals.

Continued on LIC 9099-C . . .
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Harpreet Humpal
LICENSING EVALUATOR NAME: James Sampair
LICENSING EVALUATOR SIGNATURE:

DATE: 09/08/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/08/2025
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 2
Control Number 15-AS-20250619100905
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: GINES RESIDENTIAL CARE HOME III
FACILITY NUMBER: 075601041
VISIT DATE: 09/08/2025
NARRATIVE
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. . . Continued from LIC 9099

The complaint alleges that staff do not provide R1 with a diet according to resident’s health needs.
R1 stated that they do not feed him the food he wants. ADM 1 and ADM 2 stated and the LPA observed that they are serving R1 a diabetic diet but he often refuses to eat it in favor of personally bought food or demands that he be fed non-diabetic foods such as peanut butter and jelly sandwiches. The data collected does not support the allegation.

Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove it; therefore, the allegation is UNSUBSTANTIATED.

Exit interview conducted with ADM 1 and ADM 2 and a copy of this report was provided.
SUPERVISORS NAME: Harpreet Humpal
LICENSING EVALUATOR NAME: James Sampair
LICENSING EVALUATOR SIGNATURE:

DATE: 09/08/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/08/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 2