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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 079201030
Report Date: 12/18/2025
Date Signed: 12/18/2025 05:59:44 PM

Unsubstantiated


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
08/22/2025 and conducted by Evaluator David Doidge
COMPLAINT CONTROL NUMBER: 15-AS-20250822103822
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: 131DATE:
12/18/2025
UNANNOUNCEDTIME BEGAN:
05:41 PM
MET WITH:Client Care Coordinator Kristi KomariTIME COMPLETED:
06:15 PM
ALLEGATION(S):
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Staff are not distributing resident's medications as prescribed

Staff inappropriately speaks to resident
INVESTIGATION FINDINGS:
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On 12/18/2025 at 5:41 PM, Licensing Program Analyst (LPA), David Doidge arrived unannounced to deliver complaint findings for the allegations above. LPA met with Client Care Coordinator Kristi Komari and explained the reason for the visit.

Allegation: Staff are not distributing resident's medications as prescribed

During the investigation, LPA interviewed staff and clients. LPA obtained and reviewed Resident Roster, Staff Roster, Physician Report, Progress Notes, and medication list.

Continued on LIC9099-C
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Bennett Fong
LICENSING EVALUATOR NAME: David Doidge
LICENSING EVALUATOR SIGNATURE:

DATE: 12/18/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/18/2025
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-20250822103822
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: A&A HEALTH SERVICES SAN PABLO
FACILITY NUMBER: 079201030
VISIT DATE: 12/18/2025
NARRATIVE
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During an interview with Client 1 (C1) reported that staff were not providing prescribed medications in a timely manner. C1 stated that when medication was requested, Medication Technicians often instructed C1 to return in approximately one hour. C1 expressed concerns that staff misinterpreted the situation and believed it was sexual in nature. C1 further stated that staff were jealous of treated C1 unfairly. C1 stated that three night-shift staff members frequently take breaks and long lunches and reportedly yell at C1 without cause. C1 indicated experiencing emotional distress and stated that C1 should not be spoken to in a raised or inappropriate manner. C1 declined to answer questions regarding not having a key to C1’s apartment. Staff interviews with S2 and S3 confirmed that some clients prescribed controlled substances or nicotine gum often request medication prior to scheduled times. When instructed to wait, clients may become verbally aggressive and use inappropriate language toward staff throughout the facility. Based on the information obtained this allegation is unsubstantiated.

Allegation: Staff inappropriately speaks to resident

During an interview with C1 alleged that staff frequently yell at C1 without cause and require C1 to return later for medication. C1 reported that night-shift staff routinely raise their voices and take extended breaks while C1 is in need of medication. C1 acknowledged having an outburst due to frustration related to medication access. Interview with C2, C2 reported receiving medications on time and stated they have never witnessed Medication Technicians yelling at clients. C2 reported observing other clients yelling at staff.

Interview with C3, C3 stated that medications are administered on time and reported never witnessing staff yell or use inappropriate language towards clients. C3 confirmed witnessing clients becoming verbally aggressive toward staff. C3 observed C1 leaving the interview area upset and yelling loudly, at staff when they were going on break and/or lunch. Based on the information obtained this allegation is unsubstantiated.

No deficiencies cited during visit.

Exit interview conducted and a copy of this report provided.

SUPERVISORS NAME: Bennett Fong
LICENSING EVALUATOR NAME: David Doidge
LICENSING EVALUATOR SIGNATURE:

DATE: 12/18/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/18/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 2