079201030-2-20-2026-15-AS-BFOG-DRM7Z4-20260224210544

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 079201030
Report Date: 02/20/2026
Date Signed: 02/20/2026 03:25:50 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
01/16/2026 and conducted by Evaluator Carol Fowler

COMPLAINT CONTROL NUMBER: 15-AS-20260116104644

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: 138	DATE:	02/20/2026
		UNANNOUNCED	TIME BEGAN:	01:00 PM
MET WITH:	Kristi Komori Community Care Coordinator		TIME COMPLETED:	03:45 PM

ALLEGATION(S):

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Staff allow resident to verbally threaten another resident in care.

Staff did not protect resident from harm while in care.

INVESTIGATION FINDINGS:

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On 02/20/2026 at 01:00 PM, 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 S1, S2, S3, S4, C1 and C2. 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 allow resident to verbally threaten another resident in care.

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)

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Control Number 15-AS-20260116104644

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 allowed a resident to say inappropriately and made threatening statements to another resident. LPAs interviewed C1. C1 did not want to be interviewed without ab attorney present and did not provide any more details to the department. LPAs interviewed C2. C2 said residents will swear and say rude things to one another, but staff do intervene to prevent escalation. C2 said C2 has not spoken to the police regarding verbal abuse. S1 stated that all staff are trained in CPI, de-escalation techniques, and will redirect clients by using incentives such as cigarettes or ice cream, or what ever else is available at the time. S2 stated that if there is verbal escalation they use verbal redirection to de-escalate clients, staff do not just sit back an let it happened. There is always staff or security in all areas f the facility, staff are trained to act immedicable. S3 stated that S3 tries to empty the area of other clients and tries to separate clients into rooms and offer them things such as cigarettes to calm down. S4 stated that S3 will assess the area and tries to redirect by offering resident incentives such as cigarettes breaks, Based on interviews, this allegation is UNSUBSTANTIATED.

Allegation: Staff did not protect resident from harm while in care.

Investigation Finding: It was reported to the department that staff did not protect a resident form harm. C1 did not want to be interviewed by LPAs without an attorney present. S1 stated that all staff are training in CPI training and it is a hands off facility. If there is a physical altercation, staff try to redirect verbally to separate clients and will call for outside support if unable to separate with redirection. Outside support being the police. If staff can separate the clients, clients are counseled. Non aggressors will be pulled into another room for safety.

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)

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Control Number 15-AS-20260116104644

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

All are staff reported being trained to redirect clients by using incentives such as cigarettes or ice cream, or what ever else is available at the time. All staff interviewed confirmed they are taught to be hands-off and only use verbal de-escalation techniques. 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 them, 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)

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