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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 079200855
Report Date: 08/15/2025
Date Signed: 08/15/2025 02:05:00 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
08/01/2025 and conducted by Evaluator Jill Clancy-Czuleger
COMPLAINT CONTROL NUMBER: 15-AS-20250801142840
FACILITY NAME:TODOS SANTOS ASSISTED LIVING AND MEMORY CAREFACILITY NUMBER:
079200855
ADMINISTRATOR:CLAWSON, DAVID JFACILITY TYPE:
740
ADDRESS:1081 MOHR LNTELEPHONE:
(925) 798-3900
CITY:CONCORDSTATE: CAZIP CODE:
94518
CAPACITY:160CENSUS: 132DATE:
08/15/2025
UNANNOUNCEDTIME BEGAN:
11:10 AM
MET WITH:David Clawson, DirectorTIME COMPLETED:
02:15 PM
ALLEGATION(S):
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Staff did not prevent facility from being unkempt.
Staff did not place a screen on resident's window.
Staff did not sanitize after body fluids was found in common area
Facility is locking memory care outdoor space
INVESTIGATION FINDINGS:
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On 08/15/2025 at 11:10AM, Licensing Program Analysts (LPAs) J. Clancy-Czuleger arrived unannounced to deliver findings for the above allegations. LPA explained the purpose of the visit with Administrator David Clawson.

On the allegation: Staff did not prevent the facility from being unkempt. Based on observations and interviews. S1 stated that until this week they did not have housekeeping staff designated to the memory care. When asked how the memory care was being cleaned before this week S1 said that the on-shift staff would rotate throughout the facility, and if memory care needed them, they would radio.

On the allegation: Staff did not place a screen on residents’ windows. Based on observations, LPA observed that there were at least 4 windows in the memory care courtyard without screens.

Continued on LIC 9099C...
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Harpreet Humpal
LICENSING EVALUATOR NAME: Jill Clancy-Czuleger
LICENSING EVALUATOR SIGNATURE:

DATE: 08/15/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/15/2025
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 6
Control Number 15-AS-20250801142840
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: TODOS SANTOS ASSISTED LIVING AND MEMORY CARE
FACILITY NUMBER: 079200855
VISIT DATE: 08/15/2025
NARRATIVE
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...Continued from LIC 9099
When asked, S1 said that they were unaware that there were any missing screens. LPA also observed that some of the screens that were there, had holes and were in disrepair.

On the allegation: Staff did not sanitize after body fluids was found in common areas. Based on observations and interviews on 7/7/2025 staff were informed that the courtyard smelled of urine. On 7/18/2025 staff were informed that feces was found in the courtyard, on 7/19/2025 the feces was still in the courtyard accessible to residents.

On the allegation: Facility is locking memory care outdoor space. Based on observations and interviews, the memory care door is locked from the inside at all times. The memory care courtyard is accessible from the resident rooms that are along the perimeter of the courtyard, and through a door in the memory care hallway. The hallway door is able to open from the outside to enter into the hall but is locked for those attempting to go out into the courtyard. LPA observed a stick being placed on the ground in the doorway to keep the door open.


Based on LPAs interviews, 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), is being cited on the attached LIC 9099D.

Exit interview conducted. Appeal Rights and a copy of this report provided.

SUPERVISORS NAME: Harpreet Humpal
LICENSING EVALUATOR NAME: Jill Clancy-Czuleger
LICENSING EVALUATOR SIGNATURE:

DATE: 08/15/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/15/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 6
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
08/01/2025 and conducted by Evaluator Jill Clancy-Czuleger
COMPLAINT CONTROL NUMBER: 15-AS-20250801142840

FACILITY NAME:TODOS SANTOS ASSISTED LIVING AND MEMORY CAREFACILITY NUMBER:
079200855
ADMINISTRATOR:CLAWSON, DAVID JFACILITY TYPE:
740
ADDRESS:1081 MOHR LNTELEPHONE:
(925) 798-3900
CITY:CONCORDSTATE: CAZIP CODE:
94518
CAPACITY:160CENSUS: 132DATE:
08/15/2025
UNANNOUNCEDTIME BEGAN:
11:10 AM
MET WITH:David Clawson TIME COMPLETED:
02:15 PM
ALLEGATION(S):
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Staff did not keep facility free of insects.
Administrator Qualifications
INVESTIGATION FINDINGS:
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On 08/15/2025 at 11:10AM, Licensing Program Analysts (LPAs) J. Clancy-Czuleger arrived unannounced to deliver findings for the above allegations. LPA explained the purpose of the visit with Administrator David Clawson.

On the allegation: Staff did not keep the facility free of insects. LPA did not observe any insects or other pests. Interviews with Clients and Staff revealed that there was no presence of bugs in or around the rooms.

On the allegation: Administrator Qualifications. LPA reviewed Director’s qualification, and it meets Title 22 Regulation, 87405 under Administrator – Qualification and Duties.

Although the allegations may have happened or are valid, there are not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegations are UNSUBSTANTIATED.
Exit interview conducted and a copy of this report provided.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Harpreet Humpal
LICENSING EVALUATOR NAME: Jill Clancy-Czuleger
LICENSING EVALUATOR SIGNATURE:

DATE: 08/15/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/15/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 3 of 6
Control Number 15-AS-20250801142840
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: TODOS SANTOS ASSISTED LIVING AND MEMORY CARE
FACILITY NUMBER: 079200855
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/15/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
08/26/2025
Section Cited
CCR
87470(a)(2)(A)
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Surfaces such as floors,... shall be cleaned and disinfected on a regular basis to ensure they are safe and sanitary. These surfaces shall also be disinfected when these surfaces are contaminated and visibly soiled with blood or body fluids or other potentially infectious material.
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The facility agrees to clean and sanitized the memory care outdoor space. Proof of correction will be sent to CCLD by POC date.
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This requirement was not met as evidenced by: The facility being informed on 7/7/25 that urine was found in the courtyard and not cleaning/sanitizing it until after 7/19/25.
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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: Jill Clancy-Czuleger
LICENSING EVALUATOR SIGNATURE:

DATE: 08/15/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/15/2025
LIC9099 (FAS) - (06/04)
Page: 4 of 6
Control Number 15-AS-20250801142840
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: TODOS SANTOS ASSISTED LIVING AND MEMORY CARE
FACILITY NUMBER: 079200855
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/15/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
08/29/2025
Section Cited
CCR
87303(a)
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The facility shall be clean, safe, sanitary and in good repair at all times. Maintenance shall include the provision of maintenance services and procedures for the safety and well-being of residents, employees and visitors.This requirement was not met as evidenced by:
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The facility agrees to clean the cabinets inside and out, in the memory care rec room.
Proof of correction will be sent to CCLD by POC date.
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LPA observed dirty dishes in the cabinet in the memory care rec room, as well as dirt on the walls and cabinets.
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Type B
08/29/2025
Section Cited
CCR
87303(c)
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All window screens shall be clean and maintained in good repair.This requirement was not met as evidenced by:
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The facility agrees to replace the missing screens and replace or repair the broken screens. Proof of correction will be sent to CCLD by POC date.
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four windows in memory care were missing screens and at least two more had rips in their screens.
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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: Jill Clancy-Czuleger
LICENSING EVALUATOR SIGNATURE:

DATE: 08/15/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/15/2025
LIC9099 (FAS) - (06/04)
Page: 5 of 6
Control Number 15-AS-20250801142840
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: TODOS SANTOS ASSISTED LIVING AND MEMORY CARE
FACILITY NUMBER: 079200855
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/15/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
08/29/2025
Section Cited
CCR
87219(h)(2)
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The licensee shall provide sufficient space to accommodate both indoor and outdoor activities. Activities shall be encouraged by provision of: Outdoor activity areas that are easily accessible to residents, protected from traffic, and have adequate shady areas.
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The facility agrees to unlock the patio door during daylight hours (weather permitted). Proof of correction will be sent to CCLD by POC date.
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This requirement was not met as evidenced by: the memory care patio being locked from the inside not allowing access 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: Harpreet Humpal
LICENSING EVALUATOR NAME: Jill Clancy-Czuleger
LICENSING EVALUATOR SIGNATURE:

DATE: 08/15/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/15/2025
LIC9099 (FAS) - (06/04)
Page: 6 of 6