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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 075601526
Report Date: 02/21/2023
Date Signed: 02/21/2023 05:10:22 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
02/15/2023 and conducted by Evaluator James Sampair
PUBLIC
COMPLAINT CONTROL NUMBER: 15-AS-20230215153027
FACILITY NAME:TENDER TOUCH RESIDENTIAL CARE HOME IVFACILITY NUMBER:
075601526
ADMINISTRATOR:CRUZ, ESTRELLITA S.FACILITY TYPE:
740
ADDRESS:2560 CEDRO PLACETELEPHONE:
(925) 954-7242
CITY:WALNUT CREEKSTATE: CAZIP CODE:
94598
CAPACITY:6CENSUS: 6DATE:
02/21/2023
UNANNOUNCEDTIME BEGAN:
03:00 PM
MET WITH:Estrellita CruzTIME COMPLETED:
05:30 PM
ALLEGATION(S):
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Staff are using an inappropriate lock to lock facility door.
INVESTIGATION FINDINGS:
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On 02/21/2023, Licensing Program Analyst (LPA) J. Sampair arrived unannounced to conduct a complaint inspection. LPA met with Administrator (ADM) Estrellita Cruz and informed her of the reason for the visit.

During the visit, the LPA interviewed ADM and staff member S1.

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

One (1) citation was issued (refer to LIC 9099D) and one (1) civil penalty was issued (refer to LIC 421FC).

Exit interview conducted and a copy of this report provided via email.
Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Harpreet HumpalTELEPHONE: (510) 285-3928
LICENSING EVALUATOR NAME: James SampairTELEPHONE: (510) 286-4201
LICENSING EVALUATOR SIGNATURE:

DATE: 02/21/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/21/2023
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 2
Control Number 15-AS-20230215153027
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: 02/21/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
02/22/2023
Section Cited
CCR
87468.1(a)(2)
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Personal Rights of Residents in all Facilities: (a) Residents in all residential care facilities for the elderly shall ... (2) To be accorded safe, healthful and comfortable accommodations, furnishings and equipment.

This requirement is not met as evidenced by:
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Licensee removed front door lock.
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Based on observation, the licensee did not comply with the section cited above by locking the front exit door from the inside, which poses an immediate health, safety or personal rights risk to persons in care.
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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 HumpalTELEPHONE: (510) 285-3928
LICENSING EVALUATOR NAME: James SampairTELEPHONE: (510) 286-4201
LICENSING EVALUATOR SIGNATURE:

DATE: 02/21/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/21/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 2