075601526-3-26-2021-15-AS-HHUL-BZLT2S-20210330142114

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 075601526
Report Date: 03/26/2021
Date Signed: 03/26/2021 03:14:14 PM

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
05/13/2020 and conducted by Evaluator Leslie Ibo

PUBLIC

COMPLAINT CONTROL NUMBER: 15-AS-20200513145308

FACILITY NAME:	TENDER TOUCH RESIDENTIAL CARE HOME IV		FACILITY NUMBER:	075601526
ADMINISTRATOR:	CRUZ, ESTRELLITA S.		FACILITY TYPE:	740
ADDRESS:	2560 CEDRO PLACE		TELEPHONE:	(925) 954-7242
CITY:	WALNUT CREEK	STATE: CA	ZIP CODE:	94598
CAPACITY:	6	CENSUS: 6	DATE:	03/26/2021
		UNANNOUNCED	TIME BEGAN:	01:45 PM
MET WITH:	Estrellita Cruz		TIME COMPLETED:	03:30 PM

ALLEGATION(S):

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Staff is not abiding to admission agreement

INVESTIGATION FINDINGS:

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Substantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Harpreet Humpal	TELEPHONE: (510) 285-3928
LICENSING EVALUATOR NAME: Leslie Ibo	TELEPHONE: 510-286-4201
LICENSING EVALUATOR SIGNATURE:	DATE: 03/26/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/26/2021

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-20200513145308

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 IV	FACILITY NUMBER: 075601526
	VISIT DATE: 03/26/2021

NARRATIVE

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Based on all the information obtained, the allegation is substantiated. A finding that the complaint is substantiated means that the allegation is valid because the preponderance of the evidence standard has been met.

Deficiency is cited from Title 22 California Code of Regulations (see 9099D). Any repeat violations within 12-month period may result in civil penalties.

Deficiency and plan and proof of correction were discussed with .CRUZ, ESTRELLITA S.

Exit interview conducted. Appeal Rights and copy of this report provided via e-mail.

SUPERVISOR'S NAME: Harpreet Humpal	TELEPHONE: (510) 285-3928
LICENSING EVALUATOR NAME: Leslie Ibo	TELEPHONE: 510-286-4201
LICENSING EVALUATOR SIGNATURE:	DATE: 03/26/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/26/2021

LIC9099 (FAS) - (06/04)

Page: 2 of 4

Control Number 15-AS-20200513145308

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 IV	FACILITY NUMBER: 075601526
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 03/26/2021

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 04/02/2021 Section Cited HSC 1569.652(c)	1 2 3 4 5 6 7	This requirement is not met as evidenced by: Health and Safety Code section 1569.652 provides in part:(c) A refund of any fees paid in advance covering the time after the resident’s personal property has been removed from the facility shall be issued to the individual, individuals, or entity contractually responsible for the fees or, if the deceased resident paid the fees, to the resident’s estate, within 15 days after the personal property is removed.	1 2 3 4 5 6 7	Administrator will review admission agreement for all her residents, training should be documented and sent to LPA on or before 04/02/2021.
	8 9 10 11 12 13 14	Based on interview and records review : administrator did not refund the RP’s money timely based on the facility agreement, R1 was admitted on September 2019, on November 2019 RP paid advance payment for December 2019, January 2019 with the agreement of waiving February 2020 payment . December 2019 R1 passed away, RP’s money did not get full refund not until April 9, 2020, this violates residents personal rights.	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: Leslie Ibo	TELEPHONE: 510-286-4201
LICENSING EVALUATOR SIGNATURE:	DATE: 03/26/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/26/2021

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
05/13/2020 and conducted by Evaluator Leslie Ibo

PUBLIC

COMPLAINT CONTROL NUMBER: 15-AS-20200513145308

FACILITY NAME:	TENDER TOUCH RESIDENTIAL CARE HOME IV		FACILITY NUMBER:	075601526
ADMINISTRATOR:	CRUZ, ESTRELLITA S.		FACILITY TYPE:	740
ADDRESS:	2560 CEDRO PLACE		TELEPHONE:	(925) 954-7242
CITY:	WALNUT CREEK	STATE: CA	ZIP CODE:	94598
CAPACITY:	6	CENSUS: 6	DATE:	03/26/2021
		UNANNOUNCED	TIME BEGAN:	01:45 PM
MET WITH:	Estrelita Cruz		TIME COMPLETED:	03:30 PM

ALLEGATION(S):

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Facility does not have the resources to operate effectively

INVESTIGATION FINDINGS:

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On 03/26/2021, Licensing Program Analyst (LPA) L. Ibo called the facility to deliver the complaint findings for the above allegation. LPA spoke with Administrator, CRUZ, ESTRELLITA . LPA explained due to the present shelter in place order by the Governor, the notification of the complaint is being done over the phone.
LPA interviewed RP regarding above allegation facility does not have the resources to operate effectively. Reporting party stated that Administrator gave her a postdated check on February 28 ,2020. The refund check that was given to RP did not clear to the bank. RP had a concern about financial resources of the facility.
During televisit the interview the LPA found that there is enough staffing at the facility & sufficient food supplies and other necessary needs for the residents.
Administrator gave the RP cashier’s check as final refund check on April 9,2020.
Based upon the information obtained during investigation. The above allegation is unsubstantiated. A finding that the complaint is UNSUBSTANTIATED means that although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violation occurred.

Exit interview conducted and a copy of report was given.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Harpreet Humpal	TELEPHONE: (510) 285-3928
LICENSING EVALUATOR NAME: Leslie Ibo	TELEPHONE: 510-286-4201
LICENSING EVALUATOR SIGNATURE:	DATE: 03/26/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/26/2021

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

LIC9099 (FAS) - (06/04)

Page: 4 of 4