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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 079200825
Report Date: 10/17/2025
Date Signed: 10/17/2025 10:26:52 AM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
OAKLAND ASC, 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
10/10/2025 and conducted by Evaluator Alona Gomez
COMPLAINT CONTROL NUMBER: 15-AS-20251010103344
FACILITY NAME:BLUEMEADOW CAREFACILITY NUMBER:
079200825
ADMINISTRATOR:HUANG, YANLINFACILITY TYPE:
740
ADDRESS:3262 MONTEVIDEO DRTELEPHONE:
(925) 833-2677
CITY:SAN RAMONSTATE: CAZIP CODE:
94583
CAPACITY:6CENSUS: 6DATE:
10/17/2025
UNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Administrator, Yanlin "Cynthia" HuangTIME COMPLETED:
11:00 AM
ALLEGATION(S):
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Facility did not provide adequete medication assistance
INVESTIGATION FINDINGS:
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On 10/17/2025 at 9:30AM, Licensing Program Analyst (LPA) A. Gomez arrived unannounced to conduct complaint investigation for the above allegation. LPA met with Administrator Yanlin "Cynthia" Huang and explained the purpose of the visit.

During the complaint investigation, LPA conducted a tour of the medication closet and observed pre-poured medication transferred into containers for residents. S1 stated that medication is put into the containers at nightime for the following day. LPA also observed the medication unlocked in the kitchen drawer and medication closet unlocked.

Based on LPAs observations and interview, the preponderance of evidence standard has been met, therefore the above allegation is found to be SUBSTANTIATED. California Code of Regulations (Title 22, Division 6, Chapter 8), are being cited on the attached LIC 9099D.

Exit interview conducted. Appeal Rights and a copy of this report provided.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Yvonne Flores-Larios
LICENSING EVALUATOR NAME: Alona Gomez
LICENSING EVALUATOR SIGNATURE:

DATE: 10/17/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/17/2025
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 2
Control Number 15-AS-20251010103344
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
OAKLAND ASC, 1515 CLAY STREET, STE. 310
OAKLAND, CA 94612

FACILITY NAME: BLUEMEADOW CARE
FACILITY NUMBER: 079200825
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/17/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
12/24/2025
Section Cited
CCR
87465(h)(5)
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(h) The following requirements shall apply to medications which are centrally stored(5) Each resident's medication shall be stored in its originally received container. No medications shall be transferred between containers.:
This requirment was not met evidence by:
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POC clear. Administrator retrained staff and provided an in service.
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Based on LPA's observation and interview the licensee did not coply with the section cited above by having perscription medication transferred into a container which posed a potential safety and personnel rights risk to residents 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: Yvonne Flores-Larios
LICENSING EVALUATOR NAME: Alona Gomez
LICENSING EVALUATOR SIGNATURE:

DATE: 12/24/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/24/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 2