079201030-12-30-2025-15-AS-BFOG-DQ3TYJ-20260106140849

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 079201030
Report Date: 12/30/2025
Date Signed: 12/30/2025 04:13:41 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
11/20/2025 and conducted by Evaluator David Doidge

COMPLAINT CONTROL NUMBER: 15-AS-20251120134941

FACILITY NAME:	A&A HEALTH SERVICES SAN PABLO		FACILITY NUMBER:	079201030
ADMINISTRATOR:	RIDOLFI, ELEINA L		FACILITY TYPE:	735
ADDRESS:	13956 SAN PABLO AVE		TELEPHONE:	(510) 609-4040
CITY:	SAN PABLO	STATE: CA	ZIP CODE:	94806
CAPACITY:	225	CENSUS: 132	DATE:	12/30/2025
		UNANNOUNCED	TIME BEGAN:	12:15 PM
MET WITH:	Lead Medication Technition Kristi Komari		TIME COMPLETED:	04:30 PM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Staff retaliated against resident for reporting the facility

Staff have inappropriate conversations aout resident to other residents

Staff contaminated residents drink with an unknown substance

Staff encourage residents to isolate resident socially

INVESTIGATION FINDINGS:

1
2
3
4
5
6
7
8
9
10
11
12
13

On 12/30/2025 at 12:15 PM, Licensing Program Analyst (LPAs), David Doidge and Andrew Christy arrived unannounced to deliver findings for the allegations above. LPAs met with Lead Medication Technician Kristi Komari and explained the purpose of the visit.

During the investigation, LPAs collected the following documents: Resident Roster, Staff Roster, Physician Reports (LIC602), Appraisal Needs and Services, and the Identification and Emergency Information forms for four (4) residents. LPA interviewed fi (5) staff and five (5) residents.

Allegations: Staff retaliated against resident for reporting the facility

Investigation Findings: It was reported to the department that staff have been unfairly treating a resident as a retaliation to the resident submitting a complaint to the department. R1 reported staff have been retaliating against R1 by telling other residents not to speak with R1.

Continued on LIC9099-C

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Bennett Fong
LICENSING EVALUATOR NAME: David Doidge
LICENSING EVALUATOR SIGNATURE:	DATE: 12/30/2025

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/30/2025

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 3

Control Number 15-AS-20251120134941

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: 12/30/2025

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 LIC9099

S1 informed LPA that there are some residents prefer to be alone, and have a standoff demeanor that causes other residents to avoid them. S1, S2, S3 all said that they have not seen nor heard staff retaliate against residents. S2 informed LPA that S2 knows residents have good and bad days and will keep that in mind when approaching residents. S1 reported that staff are friendly but cautious with residents. S1 and S3 reported that they actively encourage residents to socialize and participate in group activities. S3 will even approach residents and try to get them to participate when S3 sees someone by his/herself. R2, R3,and R4 all stated that they have not had negative interactions with staff nor have they observed negative interactions with staff and residents, only minor squabbles. R2, R3 and R4 all reported that staff encourage residents to interact with each other and have never been told to ignore another resident purposefully. Therefore, the allegation is unsubstantiated.

Allegation: Staff have inappropriate conversations about resident to other residents

Investigation Findings: it was reported to the department that staff have made inappropriate comments about a resident to other residents. R2, R3, R4 and R5 all stated that they have not heard staff say inappropriate things about other residents. S5 reported that S5 tells staff to treat residents with respect and as if they pay their pay checks. S4 confirmed that S5 tells staff this. S1. S2, and S3 reported that they do not talk to residents about other residents and that staff are trained to keep resident information private. S3 informed LPAs that staff are taught to take conversations regarding residents into a private room or out of earshot of other residents or staff. Therefore, the allegation is unsubstantiated.

Allegation: Staff contaminated residents drink with an unknown substance

Investigation Findings: It was reported to the department that staff put something in a resident drink that made the resident feel dizzy. R1 reported that R1 leaves drink containers in R1’s refrigerator and sometimes when R1 returns to R1’s room, R1 will take a drink and feel dizzy. R1 has never reported this to staff nor been evaluated by poison control or paramedics. R1 has never had the drinks tested. S1 and S3 did not have any knowledge of the allegation occurring, and have never had a resident report an allegation of this matter.

Continued on LIC9099-C

SUPERVISORS NAME: Bennett Fong
LICENSING EVALUATOR NAME: David Doidge
LICENSING EVALUATOR SIGNATURE:	DATE: 12/30/2025

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/30/2025

LIC9099 (FAS) - (06/04)

Page: 2 of 3

Control Number 15-AS-20251120134941

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: 12/30/2025

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 LIC9099-C

S2 reported to LPA that S2 makes rounds while on shift but does not enter any resident’s room without another staff present. S2 has never put something in anyone’s drink nor seen other staff put something into a residents drink. Therefore, the allegation is unsubstantiated.

Allegation: Staff encourage residents to isolate resident socially

Investigation Findings: It was reported to the department that staff have been telling other residents not to speak with the resident, claiming that the resident is “on the way out.” R2, R3, R4 and R5, all report that staff encourage residents to be social and interact with each other. S1 and S3 reported that they actively encourage residents to socialize and participate in group activities. S3 will even approach residents and try to get them to participate when S3 sees someone by his/herself. S2 reported that some residents like to be alone and resident respect that of others. Therefore, the allegation is unsubstantiated.

Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did occur, Therefore the allegations above are 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: 12/30/2025

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/30/2025

LIC9099 (FAS) - (06/04)

Page: 3 of 3