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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 079200174
Report Date: 02/28/2022
Date Signed: 02/28/2022 12:28:44 PM

Unsubstantiated


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
11/05/2021 and conducted by Evaluator Daisy Panlilio
COMPLAINT CONTROL NUMBER: 15-AS-20211105105834
FACILITY NAME:LINDA'S RESIDENTIAL CARE, LLCFACILITY NUMBER:
079200174
ADMINISTRATOR:ERLINDA PORTILLOFACILITY TYPE:
735
ADDRESS:4605 MENDOTA WAYTELEPHONE:
(925) 565-5106
CITY:ANTIOCHSTATE: CAZIP CODE:
94531
CAPACITY:6CENSUS: 5DATE:
02/28/2022
UNANNOUNCEDTIME BEGAN:
12:20 PM
MET WITH:Linda Portillo/Luis Fernandez, AdministratorsTIME COMPLETED:
01:00 PM
ALLEGATION(S):
1
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3
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5
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8
9
Facility did not seek medical attention for client’s continued pain after fall
INVESTIGATION FINDINGS:
1
2
3
4
5
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7
8
9
10
11
12
13
On 02/28/22, Licensing Program Analyst (LPA) D Panlilio conducted an unannounced subsequent complaint visit with administrator to deliver the findings of above allegations. LPA explained the purpose of the visit with administrators.

Allegation: Facility did not seek medical attention for client’s continued pain after fall.
Investigation Finding: UNSUBSTANTIATED
Based on interviews, observations and record reviews which were conducted, client (C1) fell off his bed at night and did not report injury to staff. However, staff noticed C1 in discomfort at the facility and transported him to the hospital for evaluation on 10/17/21 and discharged back to the facility the same day diagnosed with a sprained right knee. On 10/26/21, C1 was taken by staff back to the hospital due to continued pain. Hospital staff was ready to discharge C1 back to the facility but administrator/licensee requested for C1 to be re-examined where it was found that C1 had a broken hip. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did occur, therefore the allegation is unsubstantiated.

No deficiencies cited. Exit Interview conducted and a copy of this report provided via email.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Bennett Fong
LICENSING EVALUATOR NAME: Daisy Panlilio
LICENSING EVALUATOR SIGNATURE:

DATE: 02/28/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/28/2022
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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