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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 079201101
Report Date: 10/07/2025
Date Signed: 10/07/2025 03:13:13 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
10/03/2025 and conducted by Evaluator Laura Hall
PUBLIC
COMPLAINT CONTROL NUMBER: 15-AS-20251003153017
FACILITY NAME:ELIAS PLACEFACILITY NUMBER:
079201101
ADMINISTRATOR:RODRIGUEZ, RENEFACILITY TYPE:
735
ADDRESS:2355 GLENDALE CIRTELEPHONE:
(925) 978-4342
CITY:ANTIOCHSTATE: CAZIP CODE:
94509
CAPACITY:6CENSUS: 4DATE:
10/07/2025
UNANNOUNCEDTIME BEGAN:
01:35 PM
MET WITH:Ana Claro Columbie, Direct Support StaffTIME COMPLETED:
02:50 PM
ALLEGATION(S):
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Facility in disrepair
INVESTIGATION FINDINGS:
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On 10/7/2025, at 1:35pm, Licensing Program Analyst (LPA), L. Hall arrived unannounced conduct a 10-day initial complaint visit and deliver complaint findings for the allegation above. LPA met with Ana Claro Columbie, Direct Support Staff. Dayanis Matos Tur, Designated Staff arrived at 1:50pm, and explained the reason for the visit.

Allegation: Facility in disrepair

During the investigation LPA interviewed staff, clients, obtained and reviewed a copy of the permit for the meter and panel from the City of Pittsburg and client roster.

Continued on LIC9099C.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Harpreet Humpal
LICENSING EVALUATOR NAME: Laura Hall
LICENSING EVALUATOR SIGNATURE:

DATE: 10/07/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/07/2025
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-20251003153017
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: ELIAS PLACE
FACILITY NUMBER: 079201101
VISIT DATE: 10/07/2025
NARRATIVE
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Continued from LIC9099.

S1 stated on September 26, 2025, the lights and meter was flashing and the electrician was called. S1 was told the meter was burned. PG&E also came to the facility that day. Both the meter and the panel had to be changed, however, before that could be completed an application had to be submitted to the City of Pittsburg and PG&E. S1 stated PG&E was able to expedite the request and all power was back on October 3, 2025. S1 stated facility used battery operated lights, and the generator for the refrigerator and water heater. S1 also stated there was hot S1 stated if something else was needed they would plug into the generator. LPA interviewed three (3) of the four (4) clients. One (1) client was not at the facility. All three (3) clients stated they were able to shower and had lights (lamps) in the room to see at night.

CCLD did not receive notification of outage from the facility.

LPA tested the hot water temperature and it measured at 112.5 degreed F.

Deficiency is cited per Title 22 California Code of Regulations and listed on LIC9099D. Failure to submit proof of corrections (POC) by plan of correction due date and/or any repeat deficiencies within a 12-month period may result in civil penalties.

Exit interview conducted. A copy of the appeal rights and this report provided.
SUPERVISORS NAME: Harpreet Humpal
LICENSING EVALUATOR NAME: Laura Hall
LICENSING EVALUATOR SIGNATURE:

DATE: 10/07/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/07/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 15-AS-20251003153017
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: ELIAS PLACE
FACILITY NUMBER: 079201101
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/07/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
10/14/2025
Section Cited
CCR
80087(a)
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(a) The facility shall be clean, safe, sanitary and in good repair at all times for the safety and well-being of clients, employees and visitors.
This requirement was not met as evidence by:
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Administrator was able to get meter and panel fixed on 10/3/2025. Deficiency cleared.
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The Licensee did not comply with the section cited above in have the facility in repair at all times which poses a potential health and safety risk to persons in care.
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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: Harpreet Humpal
LICENSING EVALUATOR NAME: Laura Hall
LICENSING EVALUATOR SIGNATURE:

DATE: 10/07/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/07/2025
LIC9099 (FAS) - (06/04)
Page: 3 of 3