079200594-1-29-2026-15-AS-HHUL-DQYVWL-20260204154806

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 079200594
Report Date: 01/29/2026
Date Signed: 01/29/2026 03:37:02 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
11/03/2025 and conducted by Evaluator Grace Luk

PUBLIC

COMPLAINT CONTROL NUMBER: 15-AS-20251103161029

FACILITY NAME:	ELWYN CALIFORNIA - CAMINO SOLANO		FACILITY NUMBER:	079200594
ADMINISTRATOR:	ANGEL, LOURDES D		FACILITY TYPE:	734
ADDRESS:	1194 CAMINO SOLANO		TELEPHONE:	(408) 558-1500
CITY:	CONCORD	STATE: CA	ZIP CODE:	94521
CAPACITY:	4	CENSUS: 4	DATE:	01/29/2026
		UNANNOUNCED	TIME BEGAN:	11:20 AM
MET WITH:	Ritchie Villapando, RN		TIME COMPLETED:	03:45 PM

ALLEGATION(S):

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Staff did not ensure that resident's dental needs were met.

INVESTIGATION FINDINGS:

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On 1/29/2026 at 11:20AM, Licensing Program Analyst (LPA) G. Luk arrived unannounced to conduct a complaint investigation and deliver findings in regards to the allegation above. LPA met with RN, Ritchie Villapando and informed him the reason for visit.

During the course of investigation, LPA interviewed 3 staff, 2 witnesses, and complainant. LPA reviewed and obtained documents including Individual Program Plan, Individual Health Care Plan, care notes, dental visits notes, and emergency information.

Interview with complainant indicated that client (C1) had dental recommendation for 2 teeth extractions in November 2024 and facility staff did not follow up which resulted in C1 having 8 teeth extractions. After reviewing C1's dental visits notes, C1's dental visit on 11/29/2024 recommended C1 to follow up in 3 months for possible two teeth extractions. However, C1 did not have a dental visit until 4/5/2025 and no indication that facility staff follow up with dental provider regarding possible teeth extractions for C1. (Continue LIC9099C...)

Substantiated

Estimated Days of Completion:

SUPERVISORS NAME: Harpreet Humpal
LICENSING EVALUATOR NAME: Grace Luk
LICENSING EVALUATOR SIGNATURE:	DATE: 01/29/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/29/2026

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-20251103161029

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: ELWYN CALIFORNIA - CAMINO SOLANO	FACILITY NUMBER: 079200594
	VISIT DATE: 01/29/2026

NARRATIVE

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Interview with witnesses revealed that C1 moved to a sister facility, Elwyn California - Keith on 5/27/2025. W2 stated that the dentist recommended 2 teeth extractions for C1 in November 2024 and facility staff did not follow up with dental provider. W2 stated C1 end up having all 8 teeth extracted and C1 does not have anymore teeth currently.

Based on LPA's information obtained during investigation, the preponderance of evidence standard has been met; therefore, the above allegation is found to be SUBSTANTIATED. California Code of Regulations, Title 22, are being cited on the attached LIC9099D.

Exit interview conducted. A copy of this report and appeal rights provided.

SUPERVISORS NAME: Harpreet Humpal
LICENSING EVALUATOR NAME: Grace Luk
LICENSING EVALUATOR SIGNATURE:	DATE: 01/29/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/29/2026

LIC9099 (FAS) - (06/04)

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Control Number 15-AS-20251103161029

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: ELWYN CALIFORNIA - CAMINO SOLANO	FACILITY NUMBER: 079200594
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 01/29/2026

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type A 01/30/2026 Section Cited CCR 80075(a)	1 2 3 4 5 6 7	Health Related Services. (a) The licensee shall ensure that each client receives necessary first aid and other needed medical or dental services...This requirement is not met as evidence by:	1 2 3 4 5 6 7	Facility has agreed to create a written plan to address follow ups for client's dental care and include training for staff. Facility will submit written plan to CCLD by POC date.
	8 9 10 11 12 13 14	Based on interviews and record review, licensee did not comply with the section cited above by not following up with C1's possible 2 teeth extractions and resulted in all 8 teeth extractions which poses an immediate health and safety risk to the persons in care.	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.

SUPERVISORS NAME: Harpreet Humpal
LICENSING EVALUATOR NAME: Grace Luk
LICENSING EVALUATOR SIGNATURE:	DATE: 01/29/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/29/2026

LIC9099 (FAS) - (06/04)

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