<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 079200813
Report Date: 10/21/2022
Date Signed: 10/21/2022 03:09:08 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
02/04/2022 and conducted by Evaluator Alicia Delmundo
COMPLAINT CONTROL NUMBER: 15-AS-20220204130956
FACILITY NAME:GABRIEL'S HOUSE 1FACILITY NUMBER:
079200813
ADMINISTRATOR:BERNARDINO, JANE PABUSTANFACILITY TYPE:
740
ADDRESS:3109 CONCORD BLVDTELEPHONE:
(925) 470-7160
CITY:CONCORDSTATE: CAZIP CODE:
94519
CAPACITY:6CENSUS: 4DATE:
10/21/2022
UNANNOUNCEDTIME BEGAN:
11:45 AM
MET WITH:TIME COMPLETED:
03:10 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Facility does not have hot water.
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Licensing Program Analysts (LPAS) Alicia Delmundo and Lori Alexander arrived unannounced to continue the investigation of the above allegation and close the complaint. LPAs met with Alberto Bernardino, co-administrator.

It was alleged that facility does have hot water due to staff running the dishwasher on the time resident R1 uses the bathroom to take shower.

During the course of investigation, LPA Delmundo reviewed residents' (R1, R2., R3, R4) files. LPAs conducted interviews and tested the hot water temperature in common bathroom use by residents. LPA also checked the water heater which is a 50 gallon unit.

....continued 9099C
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Bennett FongTELEPHONE: (510) 622-2621
LICENSING EVALUATOR NAME: Alicia DelmundoTELEPHONE: (510) 286-4201
LICENSING EVALUATOR SIGNATURE:

DATE: 10/21/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/21/2022
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-20220204130956
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: GABRIEL'S HOUSE 1
FACILITY NUMBER: 079200813
VISIT DATE: 10/21/2022
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
During 2 visits to the facility, LPA Delmundo tested the hot water temperature in the common bathroom used by R1 which measured at 120 and 112.2 degrees Fahrenheit.

Staff were interviewed. According to the administrator, R1 wanted the water temperature raised above 120 degrees Fahrenheit. Admiinstrator stated that they can not raise the temperature beyond 120 as it will be out of Regulations range of 105 to 120 degrees Fahrenheit. S1 and S2 stated they run the dishwasher in the morning and afternoon but the facility never run of hot water. They both indicated that when there was a complaint about the hot water due to running the dishwasher, they stopped running the dishwasher while R1 is taking a bath. S3, S4 and S5 stated the facility didn't have incident of running out of hot water.

Residents (R2, R3) stated the hot water temperature was alright when they take showers. R4 stated staff gives R4 warm sponge bath.

Based on the information gathered, the allegation is closed as unsubstantiated. A finding that the complaint is unsubstantiated means that although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violation occurred.

No citation issued.

Exit interview conducted and copy of this report provided.

SUPERVISOR'S NAME: Bennett FongTELEPHONE: (510) 622-2621
LICENSING EVALUATOR NAME: Alicia DelmundoTELEPHONE: (510) 286-4201
LICENSING EVALUATOR SIGNATURE:

DATE: 10/21/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/21/2022
LIC9099 (FAS) - (06/04)
Page: 2 of 2