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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 079201030
Report Date: 06/09/2023
Date Signed: 06/09/2023 02:47:06 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
06/07/2023 and conducted by Evaluator Daisy Panlilio
COMPLAINT CONTROL NUMBER: 15-AS-20230607140748
FACILITY NAME:A&A HEALTH SERVICES SAN PABLOFACILITY NUMBER:
079201030
ADMINISTRATOR:RIDOLFI, ELEINA LFACILITY TYPE:
735
ADDRESS:13956 SAN PABLO AVETELEPHONE:
(510) 609-4040
CITY:SAN PABLOSTATE: CAZIP CODE:
94806
CAPACITY:225CENSUS: 121DATE:
06/09/2023
UNANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH:Betty Medici, LicenseeTIME COMPLETED:
03:00 PM
ALLEGATION(S):
1
2
3
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9
Staff do not prevent inappropriate interactions between residents in care
Residents in care have access to drugs in the facility
INVESTIGATION FINDINGS:
1
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3
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5
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13
On 06/09/23 at 1PM, Licensing Program Analyst (LPA) D Panlilio conducted an unannounced complaint visit, met with associate executive director (AED) and licensee (LC), gathered information and delivered the findings of above allegations. LPA explained the purpose of the visit with AED and LC.

Allegation: Staff do not prevent inappropriate interactions between residents in care
Investigation Finding: Unsubstantiated
During investigation, LPA interviewed staff (LC,AED, S2, S3, S4) who confirmed that when clients report any inappropriate behaviors with other residents, they immediately report the incident(s) to the licensee, administrator, authorized representative(s), community care licensing (LIC624's), 911, police and adult protective services for investigation and resolution (random references police case reports (S22-3536 and S23-2188 dated 10/22/22 & 05/27/23). Continued on next page, LIC 9099-C
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Bennett Fong
LICENSING EVALUATOR NAME: Daisy Panlilio
LICENSING EVALUATOR SIGNATURE:

DATE: 06/09/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/09/2023
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-20230607140748
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: A&A HEALTH SERVICES SAN PABLO
FACILITY NUMBER: 079201030
VISIT DATE: 06/09/2023
NARRATIVE
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Allegation: Staff do not prevent inappropriate interactions between residents in care
Investigation Finding: Unsubstantiated
Continued from LIC 9099
LPA interviewed random clients (C4, C5) during visit who stated they have not witnessed any client engage in inappropriate behaviors while at the facility. 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 that staff do not prevent inappropriate behaviors between residents in care is unsubstantiated.

Allegation: Residents in care have access to drugs in the facility
Investigation Finding: Unsubstantiated
During investigation, staff (LC, AED, S3) denied residents in care have access to drugs in the facility. LPA confirmed with staff (LC, AED, S4) that when clients return to the facility after an outing, staff always request them to show what items they are bringing in. Most of the clients refuse to do so and staff cannot force them to declare/relinquish what they have due to personal rights. LC stated she has reported drug activities outside the facility to police on several occasions. Review of random clients' (C1, C2, C4, C5) centrally stored medication logs and medication administration records show staff administered clients' medications as prescribed by their physicians. 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 that residents in care have access to drugs in the facility is unsubstantiated.
SUPERVISORS NAME: Bennett Fong
LICENSING EVALUATOR NAME: Daisy Panlilio
LICENSING EVALUATOR SIGNATURE:

DATE: 06/09/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/09/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 2