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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 079200965
Report Date: 02/20/2025
Date Signed: 02/20/2025 04:48:51 PM

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
01/24/2025 and conducted by Evaluator Tonica Syess-Gibson
PUBLIC
COMPLAINT CONTROL NUMBER: 15-AS-20250124105320
FACILITY NAME:J AND R HOME CARE LLCFACILITY NUMBER:
079200965
ADMINISTRATOR:TANG, RENEEFACILITY TYPE:
735
ADDRESS:773 SARAH STREETTELEPHONE:
(925) 634-8863
CITY:BRENTWOODSTATE: CAZIP CODE:
94513
CAPACITY:5CENSUS: 4DATE:
02/20/2025
UNANNOUNCEDTIME BEGAN:
09:50 AM
MET WITH:Eliza Capio, Direct Care StaffTIME COMPLETED:
05:07 PM
ALLEGATION(S):
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Administrator is not present in the facility a sufficient amount of time to manage the daily operations
Staff are not adequately trained
INVESTIGATION FINDINGS:
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On 02/20/2025 at 9:50AM, Licensing Program Analyst (LPA) T. Syess-Gibson arrived unannounced to conduct complaint investigation and to deliver complaint findings for the allegations above. LPA met with Direct care staff, Eliza Capio and explained the purpose of the visit. Eliza called House Manager, Joy Bisaha who arrived at 10:23AM, LPA explained the purpose of visit.

During the course of the investigation, LPA T. Syess-Gibson conducted interviews with staff, clients, and complainant. clients’ roster with contact numbers, staff training records, Personnel Record (LIC501), and a copy of the lease back agreement were obtained and reviewed.

Continue on LIC9099 C
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Harpreet Humpal
LICENSING EVALUATOR NAME: Tonica Syess-Gibson
LICENSING EVALUATOR SIGNATURE:

DATE: 02/20/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/20/2025
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 5
Control Number 15-AS-20250124105320
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: J AND R HOME CARE LLC
FACILITY NUMBER: 079200965
VISIT DATE: 02/20/2025
NARRATIVE
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Continued from LIC9099

Allegation: Administrator is not present in the facility a sufficient amount of time to manage the daily operations

Based on observation and record review, Administrator isn’t present in the facility a sufficient amount of time to manage the daily operations. LPA observed previous visits conducted Direct support staff was present. LPA observed during visits on 03/27/2023 at 12:15pm, 03/15/2024 at 2:14pm and 05/20/2024 at 2:20pm, Administrator wasn’t present during visits.

Allegation: Staff are not adequately trained

Based on record review LPA observed S3 and S6 training recorders were not current and S4, S5 and S7 training records were missing.. LPA observed S3 training records were dated 08/02/2023 and S6 training records were dated 06/29/2023.

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. A copy of this report and appeal rights provided.
SUPERVISORS NAME: Harpreet Humpal
LICENSING EVALUATOR NAME: Tonica Syess-Gibson
LICENSING EVALUATOR SIGNATURE:

DATE: 02/20/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/20/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 5
Control Number 15-AS-20250124105320
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: J AND R HOME CARE LLC
FACILITY NUMBER: 079200965
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/20/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
02/27/2025
Section Cited
CCR
85064(e)
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85064 Administrator Qualifications and Duties(e)The administrator shall be on the premises the number of hours necessary to manage and administer the facility in compliance with applicable law and regulation.

This requirement is not as evidence by:
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The facility shall develop and implement a plan which ensures the Administrator meet the required hours necessary to manage and administer the facility and send CCLD an email by POC date.
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Based on observation, licensee did not comply with the section cited above by not being on the premise the number of hours necessary to manage and administer the facility in compliance with applicable law and regulation.
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Type B
02/27/2025
Section Cited
CCR
80065(f)
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80065 Personnel Requirements
(f) All personnel shall be given on-the-job training or shall have related experience which provides knowledge of and skill in the following areas, as appropriate to the job assigned and as evidenced by safe and effective job performance…..
This requirement is not as evidence by:
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The facility shall develop and implement a plan which ensure all staff will receive the required training, place all current trainings in personnel files. Send CCLD an email of completed trainigs by POC date.
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Based on record review , licensee did not comply with the section cited above by not conducting annual training for staff. which poses a potential health, safety and personal rights risk to clients 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: Tonica Syess-Gibson
LICENSING EVALUATOR SIGNATURE:

DATE: 02/20/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/20/2025
LIC9099 (FAS) - (06/04)
Page: 3 of 5
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
01/24/2025 and conducted by Evaluator Tonica Syess-Gibson
PUBLIC
COMPLAINT CONTROL NUMBER: 15-AS-20250124105320

FACILITY NAME:J AND R HOME CARE LLCFACILITY NUMBER:
079200965
ADMINISTRATOR:TANG, RENEEFACILITY TYPE:
735
ADDRESS:773 SARAH STREETTELEPHONE:
(925) 634-8863
CITY:BRENTWOODSTATE: CAZIP CODE:
94513
CAPACITY:5CENSUS: 4DATE:
02/20/2025
UNANNOUNCEDTIME BEGAN:
09:50 AM
MET WITH:Eliza Capio, Care StaffTIME COMPLETED:
05:07 PM
ALLEGATION(S):
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9
Licensee did not report a change in ownership
Staff yell at clients
INVESTIGATION FINDINGS:
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On 02/20/2025 at 9:50AM, Licensing Program Analyst (LPA) T. Syess-Gibson arrived unannounced to conduct complaint investigation and to deliver complaint findings for the allegations above. LPA met with Direct care staff, Eliza Capio and explained the purpose of the visit. Eliza called House Manager, Joy Bisaha. Joy Bisaha arrived at 10:23AM, LPA explained the purpose of visit.

During the course of the investigation, LPA T. Syess-Gibson conducted interviews with staff, clients, and complainant. clients’ roster with contact numbers, staff training records, Personnel Record (LIC501), and a copy of the lease back agreement were obtained and reviewed.


Continue LIC9099C
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Harpreet Humpal
LICENSING EVALUATOR NAME: Tonica Syess-Gibson
LICENSING EVALUATOR SIGNATURE:

DATE: 02/20/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/20/2025
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 5
Control Number 15-AS-20250124105320
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: J AND R HOME CARE LLC
FACILITY NUMBER: 079200965
VISIT DATE: 02/20/2025
NARRATIVE
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Continued from LIC9099



Allegation: Staff yell at clients
Interview with staff and clients revealed that staff does not yell at clients. Clients stated that staff are friendly to clients and hasn't heard of staff yelling at the other clients. Interview with staff indicated that staff treat clients with dignity and respect. Staff have not witnessed staff being rude or mistreating clients.


Allegation: Licensee did not report a change in ownership

Based on record review and interviews , Licensee did report a change in property ownership and provided CCL a copy of the lease back agreement dated back in 2023. LPA contacted the Contra Costa County Assessor’s Office and was informed of the name(s) of property owners. LPA reviewed the lease back agreement and observed the owner’s name on lease back agreement is the same owner as the representative with Contra Costa County Assessor’s Office provided.

Although the allegations may have happened or is valid, there is not a preponderance of evidence to prove the alleged violations did occur, therefore the allegations are UNSUBSTANTIATED.

Exit interview conducted and a copy of this report provided.

SUPERVISORS NAME: Harpreet Humpal
LICENSING EVALUATOR NAME: Tonica Syess-Gibson
LICENSING EVALUATOR SIGNATURE:

DATE: 02/20/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/20/2025
LIC9099 (FAS) - (06/04)
Page: 5 of 5