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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 079200174
Report Date: 07/29/2022
Date Signed: 07/29/2022 03:17:38 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
07/20/2022 and conducted by Evaluator Daisy Panlilio
COMPLAINT CONTROL NUMBER: 15-AS-20220720135743
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:
07/29/2022
UNANNOUNCEDTIME BEGAN:
01:30 PM
MET WITH:Luis Fernandez, Administrator
Colomba Marquez, DSP		TIME COMPLETED:
03:30 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Insufficient staffing according to staff required by resident's care plan
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
On 07/29/22 at 1:30PM, Licensing Program Analyst (LPA) Daisy Panlilio arrived unannounced to conduct a complaint visit, gather information and deliver investigation findings to administrator. LPA explained the purpose of the visit with administrator.

During visit, LPA observed there were 2 Direct Service Professionals (DSP1, DSP2) assisting the 5 clients. Review of clients individual service plans show no one on one client requirement at the facility. Prior LPA unannounced visits on 02/28/22 and 11/05/2021 confirm 2 staff working at the facility.

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: 07/29/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/29/2022
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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