075601041-9-10-2025-15-AS-YFLS-DM7QGG-20251006120931

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 075601041
Report Date: 09/10/2025
Date Signed: 09/10/2025 10:56:17 AM

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
07/01/2025 and conducted by Evaluator Alona Gomez

COMPLAINT CONTROL NUMBER: 15-AS-20250701150452

FACILITY NAME:	GINES RESIDENTIAL CARE HOME III		FACILITY NUMBER:	075601041
ADMINISTRATOR:	GINES, ERLINDA		FACILITY TYPE:	740
ADDRESS:	2565 STONE VALLEY ROAD		TELEPHONE:	(925) 743-1146
CITY:	ALAMO	STATE: CA	ZIP CODE:	94507
CAPACITY:	6	CENSUS: 5	DATE:	09/10/2025
		UNANNOUNCED	TIME BEGAN:	08:25 AM
MET WITH:	Administrator, Erlinda Gines		TIME COMPLETED:	11:20 AM

ALLEGATION(S):

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Staff illegally evicted a resident in care
Staff is not competent to provide care
Staff is mismanaging residents medication
Staff is not assisting with incidental medical care
Administrator is not qualified to carry out their necessary duties

INVESTIGATION FINDINGS:

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On 9/10/2025, at 8:25 AM, Licensing Program Analyst (LPA) A Gomez arrived unannounced to deliver investigation findings concerning the allegations above. Upon entry, the LPA informed Licensee/ Administrator Erlinda Gines of the reason for the visit.

During the investigation, LPA reviewed the files for R1 and requested copies of R1's full file, staff roster, and all staff trainings. LPA also received additional documentation from W1. On the allegations Staff illegally evicted a resident in care, Staff is not competent to provide care, Staff is mismanaging residents medication, Staff is not assisting with incidental medical care, and Administrator is not qualified to carry out their necessary duties the following was found:

Report continues on LIC9099-C

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Yvonne Flores-Larios
LICENSING EVALUATOR NAME: Alona Gomez
LICENSING EVALUATOR SIGNATURE:	DATE: 09/10/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/10/2025

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

LIC9099 (FAS) - (06/04)

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Control Number 15-AS-20250701150452

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: 09/10/2025

NARRATIVE

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On 6/22/2025 an eviction notice was issued to R1 for repeated violation of the facilities house rules. An additional eviction notice was issued on 9/2/2025 for non-payment of August 2025 rent and partial payment of July 2025. LPA reviewed incident reports for R1 and found multiple incidents documented from 6/4/2025 – Present alleging that R1 had in some way violated the house rules and/or other residents personal rights. LPA observed that R1’s care plan dated 4/22/2025 and physicians report dated 5/23/2025 noted R1 as being angry with outbursts however the facility alleged that R1's behaviors were escalating. On 8/16/2025 the facility notified residents that they would be installing cameras in common areas. On 8/26/2025 LPA visited the facility for a case management because it was alleged that R1 assaulted a staff member. During the visit LPA observed R1 yelling and cursing in common areas without provocation. LPA also reviewed camera footage and observed R1 going into another residents room while they were having their incontinence changed and also blocking the caregivers from allowing police into the facility by pressing their feet against the door. LPA requested that a new appraisal and physicians report be done for R1 to assess their change in condition. On 8/26/2025 LPA observed that the facility helped to facilitate the required incidental medical assistance for R1 to receive possible medication assistance and a new physicians assessment. R1 later refused to go to the appointments and update their care plan according to Administrator and W1. LPA observed that the administrator holds a valid administrator certificate and that their backup administrator was knowledgeable of procedures. All staff are also current on their required training's. Facility does not have a MAR but LPA reviewed the medication and was unable to locate where the facility did not provide medications to R1 as prescribed. Throughout the investigations LPA received correspondences from W1 who corroborated that R1's behaviors are escalating and R1 is refusing assistance for their change in condition. Therefore, the above allegations are 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 allegation is UNSUBSTANTIATED.

No deficiencies cited during visit. Exit interview conducted and a copy of this report provided.

SUPERVISORS NAME: Yvonne Flores-Larios
LICENSING EVALUATOR NAME: Alona Gomez
LICENSING EVALUATOR SIGNATURE:	DATE: 09/10/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/10/2025

LIC9099 (FAS) - (06/04)

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