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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 079200778
Report Date: 06/05/2025
Date Signed: 06/05/2025 04:38:34 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
10/31/2024 and conducted by Evaluator Grace Luk
PUBLIC
COMPLAINT CONTROL NUMBER: 15-AS-20241031100224
FACILITY NAME:SOPHIA'S HOMEFACILITY NUMBER:
079200778
ADMINISTRATOR:HAYAG, LORNAFACILITY TYPE:
735
ADDRESS:5243 CONCORD BLVDTELEPHONE:
(925) 683-1818
CITY:CONCORDSTATE: CAZIP CODE:
94521
CAPACITY:6CENSUS: 5DATE:
06/05/2025
UNANNOUNCEDTIME BEGAN:
12:30 PM
MET WITH:Lorna Hayag, AdministratorTIME COMPLETED:
04:50 PM
ALLEGATION(S):
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Staff did not follow proper reporting requirements
Administrator is not on the facility premises a sufficient number of hours
INVESTIGATION FINDINGS:
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On 6/5/2025 at 12:30PM, Licensing Program Analyst (LPA) G. Luk arrived unannounced to conduct a complaint investigation and deliver findings in regards to the allegations above. LPA met with staff, Margarita Balbaguen and informed her the reason for visit. Administrator, Lorna Hayag arrived an hour later.

During the course of investigation, LPA interviewed 3 staff, 4 clients, and complainant. LPA reviewed and obtained documents including physician's report, individual program plan (IPP), individual service plan (ISP), emergency information, and incident reports.

Staff did not follow proper reporting requirements
Interview with S1 revealed that the facility reported the incident between two clients to Regional Center of the East Bay (RCEB) and Community Care Licensing Division (CCLD). S1 stated that facility did not report incident to Ombudsman.
(Continue on LIC9099C...)
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Harpreet Humpal
LICENSING EVALUATOR NAME: Grace Luk
LICENSING EVALUATOR SIGNATURE:

DATE: 06/05/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/05/2025
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-20241031100224
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: SOPHIA'S HOME
FACILITY NUMBER: 079200778
VISIT DATE: 06/05/2025
NARRATIVE
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Administrator is not on the facility premises a sufficient number of hours
Interview with clients revealed that administrator is at the facility once a week. W1 have gone to the facility on five different dates and did not see the administrator present at the facility.

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

Exit interview conducted with Lorna Hayag. A copy of this report and appeal rights provided.
SUPERVISORS NAME: Harpreet Humpal
LICENSING EVALUATOR NAME: Grace Luk
LICENSING EVALUATOR SIGNATURE:

DATE: 06/05/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/05/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 4
Control Number 15-AS-20241031100224
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: SOPHIA'S HOME
FACILITY NUMBER: 079200778
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/05/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
06/20/2025
Section Cited
CCR
80061(d)
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Reporting Requirements. Any suspected physical abuse that does not result in serious bodily injury of an elder or dependent adult shall be reported to the local ombudsman... This requirement is not met as evidence by:
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Administrator has agreed to review reporting requirements and submit self-certification to CCLD by POC date.
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Based on interview, licensee did not comply with the section cited above by not report to ombudsman which poses a potential health and safety risk to the persons in care.
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Type B
06/20/2025
Section Cited
CCR
85064(e)
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Administrator Qualifications and Duties. The administrator shall be on the premises the number of hours necessary to manage ...the facility... This requirement is not met as evidence by:
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Administrator has agreed to submit an updated LIC500 and be at the facility for a sufficient number of hours. Administrator will submit the updated LIC500 to CCLD by POC date.
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Based on interviews, licensee did not comply with the section cited above by not having an administrator present at the facility for a sufficient number of hours which poses a potential health and safety risk to the 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.
SUPERVISORS NAME: Harpreet Humpal
LICENSING EVALUATOR NAME: Grace Luk
LICENSING EVALUATOR SIGNATURE:

DATE: 06/05/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/05/2025
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
10/31/2024 and conducted by Evaluator Grace Luk
PUBLIC
COMPLAINT CONTROL NUMBER: 15-AS-20241031100224

FACILITY NAME:SOPHIA'S HOMEFACILITY NUMBER:
079200778
ADMINISTRATOR:HAYAG, LORNAFACILITY TYPE:
735
ADDRESS:5243 CONCORD BLVDTELEPHONE:
(925) 683-1818
CITY:CONCORDSTATE: CAZIP CODE:
94521
CAPACITY:6CENSUS: 5DATE:
06/05/2025
UNANNOUNCEDTIME BEGAN:
12:30 PM
MET WITH:Lorna Hayag, AdministratorTIME COMPLETED:
04:50 PM
ALLEGATION(S):
1
2
3
4
5
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7
8
9
Staff did not prevent physical altercation between residents
INVESTIGATION FINDINGS:
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3
4
5
6
7
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9
10
11
12
13
On 6/5/2025 at 12:30PM, 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 staff, Margarita Balbaguen and informed her the reason for visit. Administrator, Lorna Hayag arrived an hour later.

During the course of investigation, LPA interviewed 3 staff, 4 clients, and complainant. LPA reviewed and obtained physician's report, individual program plan (IPP), individual service plan (ISP), emergency information, and incident reports. Interview with clients and staff revealed there was an incident regarding a physical altercation where C4 pushed C1. At the time of the incident, S2 was present and separated the clients after altercation.

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. Exit interview conducted with Lorna Hayag. A copy of this report provided.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Harpreet Humpal
LICENSING EVALUATOR NAME: Grace Luk
LICENSING EVALUATOR SIGNATURE:

DATE: 06/05/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/05/2025
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