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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 075601041
Report Date: 09/18/2025
Date Signed: 09/18/2025 10:50:28 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
09/10/2025 and conducted by Evaluator Alona Gomez
COMPLAINT CONTROL NUMBER: 15-AS-20250910140047
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:
09/18/2025
UNANNOUNCEDTIME BEGAN:
08:50 AM
MET WITH:Licensee/ Administrator, Erlinda GinesTIME COMPLETED:
11:00 AM
ALLEGATION(S):
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Facility does not have staff on duty at night
Staff does not ensure resident is provided drinking water
INVESTIGATION FINDINGS:
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On 9/18/2025, at 8:50 AM, Licensing Program Analysts (LPAs) A Gomez and J Sampair arrived unannounced to conduct an initial 10-day complaint investigation and deliver findings concerning the allegations above. Upon entry, the LPAs informed staff 2 (S2) of the reason for the visit. Licensee/ Administrator Erlinda Gines was notified and arrived at 9:20 AM.

LPAs conducted interviews, toured facility, reviewed camera footage, and reviewed documets.

Report continues on LIC9099-C
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Yvonne Flores-Larios
LICENSING EVALUATOR NAME: Alona Gomez
LICENSING EVALUATOR SIGNATURE:

DATE: 09/18/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/18/2025
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-20250910140047
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: 09/18/2025
NARRATIVE
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On the allegations Facility does not have staff on duty at night and Staff does not ensure resident is provided drinking water the following was found:

LPAs reviewed camera footage available at the facility for the month of September focusing on the night hours. LPAs observed staff on camera providing care/supervision at night. LPAs reviewed the staff roster along with their schedule and observed that there is at least one staff available on call at night for each night of the week. Therefore the allegation of Facility does not have staff on duty at night is UNSUBSTANTIATED.

LPAs also toured the kitchen and observed water bottles available in the pantry as well as cold water from a Britta pitcher available in the refrigerator. Facility states that they primarily utilize the pitcher water offered to residents in a glass. LPAs interviewed S2, Administrator, and Backup Administrator who all confirmed that water is available for all residents. S2 and Administrator states that R1 declines the facilities water and insists on drinking the water that they purchased for themselves. Therefore the allegation of Staff does not ensure resident is provided drinking water is UNSUBSTANTIATED.

Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations 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: 09/18/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/18/2025
LIC9099 (FAS) - (06/04)
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