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

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 079201030
Report Date: 04/08/2025
Date Signed: 04/08/2025 04:58:14 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
04/03/2025 and conducted by Evaluator Carol Fowler
COMPLAINT CONTROL NUMBER: 15-AS-20250403152807
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: 136DATE:
04/08/2025
UNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:HEATER PAYNE, CLIENT CARE DIRECTORTIME COMPLETED:
05:15 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Staff did not safeguard resident's personal property
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
On 04/08/2025 at 9:30AM, Licensing Program Analysts (LPAs) Carol Fowler and David Doidge arrived unannounced to conduct a 10 day initial visit and deliver findings for the allegation above. Upon arrival, LPAs met with Heather Payne Client Care Director and spoke with Chief Compliance Officer Rajdeep Thandi and explained the reason for the visit.

During the course of the investigation, the Department conducted a tour and interviews with staff, S1, S2, S3 S4 and S5 and clients C1, C2 and C3. The Department obtained and reviewed the facility & staff roster, physicians reports, incident reports, progress notes, preplacement appraisal information sheet, psychiatric behavioral assement, after visit summary and evaluation form and police reports.

continue on LIC 9099


Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Bennett Fong
LICENSING EVALUATOR NAME: Carol Fowler
LICENSING EVALUATOR SIGNATURE:

DATE: 04/08/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/08/2025
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
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
04/03/2025 and conducted by Evaluator Carol Fowler
COMPLAINT CONTROL NUMBER: 15-AS-20250403152807

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: 136DATE:
04/08/2025
UNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:HEATER PAYNE, CLIENT CARE DIRECTORTIME COMPLETED:
05:15 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Staff did not intervene when residents assaulted another resident
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
On 04/08/2025 at 9:30AM, Licensing Program Analysts (LPAs) Carol Fowler and David Doidge arrived unannounced to conduct a 10 day initial visit and deliver findings for the allegation above. Upon arrival, LPAs met with Heather Payne Client Care Director and spoke with Chief Compliance Officer Rajdeep Thandi and explained the reason for the visit.

During the course of the investigation, the Department conducted a tour and interviews with staff, S1, S2, S3 S4 and S5 and clients C1, C2 and C3. The Department obtained and reviewed the facility & staff roster, physicians reports, incident reports, progress notes, preplacement appraisal information sheet, psychiatric behavioral assessment, after visit summary and evaluation form and police reports.

continue on LIC 9099
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Bennett Fong
LICENSING EVALUATOR NAME: Carol Fowler
LICENSING EVALUATOR SIGNATURE:

DATE: 04/08/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/08/2025
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-20250403152807
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: 04/08/2025
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
continued from LIC 9099A

Allegation: Staff did not intervene when residents assaulted another resident
Investigation Finding: UNSUBSTANTIATED

RP reported Staff did not intervene when residents assaulted another resident. Interviews with staff and clients revealed that the facility intervened during altercations between clients C1, C2 and C3. While interviewing C1 revealed that when C1 is triggered C1 shouts and calls people names and makes racial slurs. C1 stated that after C1 calms down C1 is sorrowful for C1's words. Interview with C2 revealed that C1 called C2 a bitch and the N word. C2 stated C2 then lost control and slapped C1 around. C2 also stated that C1 told C2 to go back to where C2 came from. Interview with C3 revealed that C3 was C1 roommate and C1 seemed to be nice, but started calling C3 a bitch and N word which triggered C3. C3 stated that C1 would be talking a lot of stuff and would be upsetting C3. C3 stated that C1 accused C3 and a friend of C3 of stealing C1s items such as clothes, food, water, soda and a red Jesus hat. C3 also stated that C1 talks talks and talks and calls C3 the N word and bitch along with other African American Clients in the facility. C3 stated that C3 got upset when C1 was calling C3 the N word and talking about C3's friend and C3 threw a chair at C1. C3 also stated that C1 is not innocent and is really aggressive with C1's words. Interview with S1 revealed that C1 has been targeting the African American clients and calling them the N word. Interview with S2 revealed that C1 was roommates with C3 for a short period of them when C1 first moved into the facility, and C3 was moved to another apartment. S2 stated that C1 also uses racial slurs with staff as well. S2 stated that C1 uses multiple racial slurs with staff and clients, the facility is in talks with C1 case manager about moving C1 to a facility that would be a better fit for C1. Interview with S3 revealed that C1 is not aggressive but is verbally abusive with C1 words, S3 can recall one time when C1 triggered another client C2 with racial slurs and C2 slapped C1 and staff intervened by separating and redirecting the two and called the police. Interview with S4 revealed that C1 was using racial slurs and a client that has been moved got upset and hit C1, the staff intervened by separating and redirecting the clients and calling the police. Interview with S5 stated S5 heard C1 saying no don't take my walker and S5 ran out and C1 stated that a client which has been moved from the facility was beating C1. S5 called security while separating the two. S5 also stated that C1 stated that C1 is tired of living with these N words all around and was pointing at African American clients. S5 also stated that C1 has called S5 the N word as well.

continued on LIC 9099 C2
SUPERVISORS NAME: Bennett Fong
LICENSING EVALUATOR NAME: Carol Fowler
LICENSING EVALUATOR SIGNATURE:

DATE: 04/08/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/08/2025
LIC9099 (FAS) - (06/04)
Page: 4 of 6
Control Number 15-AS-20250403152807
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: 04/08/2025
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
Continued form LIC 9099C

Interviews with staff, clients and document reviews revealed that when the altercations happened staff was there to intervene by separating clients trying to redirect contacting the police department and also triage the clients. Therefore this allegation is UNSUBSTANTIATED.

Based on interviews and records review, there is not a preponderance of evidence to prove the alleged violation occurred; therefore, the allegation is closed as unsubstantiated.

No deficiency cited.

Exit interview conducted and a copy of this report provided.

SUPERVISORS NAME: Bennett Fong
LICENSING EVALUATOR NAME: Carol Fowler
LICENSING EVALUATOR SIGNATURE:

DATE: 04/08/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/08/2025
LIC9099 (FAS) - (06/04)
Page: 5 of 6
Control Number 15-AS-20250403152807
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: 04/08/2025
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
continue from LIC 9099

Allegation: Staff did not safeguard resident's personal property
Investigation Finding: SUBSTANTIATED

RP reported Staff did not safeguard resident's personal property. Interview with staff, client and LPA observation revealed that the facility did not safeguard clients belongings. While interviewing C1, C1 stated that C1 door lock is broken and belongings such as a red Jesus hat, soda, water, food, clothes and hygiene products were missing from C1's apartment. LPAs conducted a tour of C1s room and observed that the deadbolt lock is broken so the door is unable to lock. C1 is not able to have personal items secured in the apartment. Therefore this allegation is SUBSTANTIATED.

Based on the Department’s investigation, the preponderance of evidence standard has been met; therefore, the above allegation is 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: Bennett Fong
LICENSING EVALUATOR NAME: Carol Fowler
LICENSING EVALUATOR SIGNATURE:

DATE: 04/08/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/08/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 6
Control Number 15-AS-20250403152807
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
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/08/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
04/15/2025
Section Cited
CCR
80087(a)
1
2
3
4
5
6
7
80087 Buildings and Grounds
(a)The facility shall be clean…and in good repair at all times for…well-being of clients,…and visitors
1
2
3
4
5
6
7
Administrator agrees to repair broken lock and provide client with a key. DEFICIENCY CLEARED DURING VISIT.
8
9
10
11
12
13
14
Based on LPAs observation, C1's deadbolt lock on door was broken
8
9
10
11
12
13
14
1
2
3
4
5
6
7
1
2
3
4
5
6
7
1
2
3
4
5
6
7
1
2
3
4
5
6
7
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: Bennett Fong
LICENSING EVALUATOR NAME: Carol Fowler
LICENSING EVALUATOR SIGNATURE:

DATE: 04/08/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

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