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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 079201030
Report Date: 02/20/2026
Date Signed: 02/20/2026 03:27:51 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
08/06/2025 and conducted by Evaluator Carol Fowler
COMPLAINT CONTROL NUMBER: 15-AS-20250806151659
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: 138DATE:
02/20/2026
UNANNOUNCEDTIME BEGAN:
10:30 AM
MET WITH:ELEINA RIDOLFI, EXECUTIVE DIRECTORTIME COMPLETED:
12:15 PM
ALLEGATION(S):
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Staff did not keep the facility free from pest infestation

Staff did not ensure resident's hygiene needs were met
INVESTIGATION FINDINGS:
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On 02/20/2026 at 10:30 AM, Licensing Program Analysts (LPAs), Carol Fowler and David Doidge arrived unannounced to deliver complaint findings for the allegations above. LPA met with Eleina Ridolfi, Executive Director and Kristi Komori Community Care Coordinator and explained the reason for the visit.

During the investigation LPAs toured the facility and conducted staff and resident interviews. LPAs interviewed W1, S1, S2, S3, S4, C2 and C3. The following documents were collected by LPAs: Resident Roster, Facility Staff Schedule, Staff Roster, Physician Report, Progress Notes, Preplacement Appraisal form, SOC 341 and Incident Reports for Client 1 (C1).

Allegation: Staff did not keep the facility free from pest infestation

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

DATE: 02/20/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/20/2026
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-20250806151659
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: 02/20/2026
NARRATIVE
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Continued from LIC9099

Investigation Finding: It was reported to the department that the facility may have a pest infestation due to the bugs found on C1’s body and hair. S2 stated that S4 checked C1’s room for bugs, including bed bugs, and none were found. Interview with S3 revealed that S4 checked for beds bug, found no bugs, but C1’s room was treated as a precaution. Interview with S4 stated that C1’s room was checked, there was no bugs, but the room was treated by Clark Pest Control for safety as a precaution. Clarke is scheduled to come out to the facility weekly to spray for bugs. LPAs received a copy of the pest control report which shows no pest issues at the time.

Allegation: Staff did not ensure resident's hygiene needs were met

Investigation Finding: It was reported to the department that C1 was admitted to the hospital and had bugs in hair and was being treated for body lice. C1’s shoes were stuck to feat due to dried blood. C1 moved to the facility March 2025, and has been eaten by the bugs during stay. Interview with S1 revealed that the facility does not have hands on caregivers, however hygiene supplies are supplied to all residents, and each resident is expected to take care of own hygiene. The facility offers classes on self care. Clients are responsible for their own laundry, and have access to laundry services twenty four hours a day. The facility also has a monthly on-site spa day, in which clients can get hair, nail and feet care for free. S2 reported seeing red and flaky skin on C1, and asked C1 if S2 could see C1’a ankles. C1 declined. S2 called S1 and asked what to do. S2 stated that C1 is not conserved and was homeless, living in a shelter, and not keeping up with hygiene. C1 was provided hygiene supplies and offered to attend spa days. C1 mainly stayed in C1’s room and care staff would take food to C1. Once C1 expressed pain, the facility called non-emergency at 1:00 AM to transport C1 to the hospital. S3 reported that C1 was provided with hygiene supplies such as soap, shampoo, toothpaste, shaving supplies, and towels. The facility encourages clients to attend life skills training, which covers basic hygiene. C1 was admitted to the facility without clothes. The facility bought C1 clothing. C1 changed clothes once during stay, and lived in the facility for four to five months.

Continued on LIC9099-C

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

DATE: 02/20/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/20/2026
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 15-AS-20250806151659
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: 02/20/2026
NARRATIVE
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Continued from LIC9099-C

C1 was not social and would sometimes come out to eat, and then go right back to C1’s room. Interview with C2 revealed that when C2 arrived arrived at the facility, C2 received a hygiene kit containing hygiene supplies such as soap, shampoo, toothpastes, toothbrush, etc.. C2 was encouraged to attend program and spa days. Interview with C3 revealed that when C3 moved in, C3 received a hygiene kit as well. C3 was taken by the facility to the dentist, and attended self-care classes. Based on interviews, this allegation is UNSUBSTANTIATED.

Although the above allegations may have happened or are valid, there is not a preponderance of evidence to prove it; therefore, the allegations are UNSUBSTANTIATED.

No deficiencies cited during visit.

Exit interview conducted and a copy of this report provided.

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

DATE: 02/20/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/20/2026
LIC9099 (FAS) - (06/04)
Page: 3 of 3