079201128-3-11-2026-15-AS-HHUL-DSHKYD-20260325081859

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 079201128
Report Date: 03/11/2026
Date Signed: 03/11/2026 03:29:44 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
12/12/2025 and conducted by Evaluator Tonica Syess-Gibson

PUBLIC

COMPLAINT CONTROL NUMBER: 15-AS-20251212084904

FACILITY NAME:	NICOLE HOME		FACILITY NUMBER:	079201128
ADMINISTRATOR:	FERNANDEZ, FERNANDO C.		FACILITY TYPE:	735
ADDRESS:	613 MARATHON DRIVE		TELEPHONE:	(510) 861-5810
CITY:	OAKLEY	STATE: CA	ZIP CODE:	94561
CAPACITY:	6	CENSUS: 3	DATE:	03/11/2026
		UNANNOUNCED	TIME BEGAN:	10:18 AM
MET WITH:	Fernando Fernandez, Administrator		TIME COMPLETED:	03:45 PM

ALLEGATION(S):

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Staff does not speak to resident in an appropriate manner
Staff handles resident in a rough manner
Staff does not ensure resident is accorded supervision at all times while in care
Staff does not ensure resident is provided with personal hygiene assistance

INVESTIGATION FINDINGS:

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On 03/11/2026 at 10:18am, Licensing Program Analyst (LPA), T. Syess-Gibson arrived unannounced to conduct an investigation and deliver complaint findings for the allegations above. LPA met with Fernando Fernandez, Administrator, and explained the reason for the visit

During the investigation, LPA interviewed four (4) staff, two (2) clients, reviewed and obtained the following documents: Client’s roster, staff schedules dated 12/08/2025-12/21/2025, staff contact information, client’s (C1’s) admission agreement, individual performance plan (IPP), dangerous propensity, identification and emergency information, incident reports and physician report.

Continued on LIC9099C.....

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Harpreet Humpal
LICENSING EVALUATOR NAME: Tonica Syess-Gibson
LICENSING EVALUATOR SIGNATURE:	DATE: 03/11/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/11/2026

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-20251212084904

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: NICOLE HOME	FACILITY NUMBER: 079201128
	VISIT DATE: 03/11/2026

NARRATIVE

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Continued from LIC9099

Allegation: Staff does not speak to resident in an appropriate manner
During interviews with staff, S1 stated that there is a zero policy for staff to mistreat any of the clients at the home. S2, S3, S4 stated haven’t witnessed or heard of any staff members speaking to the clients in an inappropriate manner. During interviews with clients, C1, C2 stated all the staff treat them nicely and they like living at home. C1, C2 stated they did not observe nor hear any staff being disrespectful.

Allegation: Staff handles resident in a rough manner
During interviews, S1 stated hasn’t witnessed or heard of any staff members handling clients in a rough manner, staff have been asked to report abuse to licensing, RCEB and S1. During interviews with S2, S3, and S4, it was stated that staff haven’t witnessed or heard of any other staff handling clients in a rough manner, clients would say something if they were being handled roughly. During interviews with C1, C2, it was stated that staff are nice to them and do not handle them in a rough manner.

Allegation: Staff does not ensure resident is accorded supervision at all times while in care
During interviews, S1 stated there are only three clients living at the home and each client has a staff member assigned to them for supervision and care needs (1:1). S2, S3, S4 stated they are assigned a client weekly, there are always staff present and with clients, clients are never left unsupervised. During interviews with C1, C2, it was stated that staff are always at home with them. C1, C2 stated they are never left alone at home.

Continue on LIC9099C...

SUPERVISORS NAME: Harpreet Humpal
LICENSING EVALUATOR NAME: Tonica Syess-Gibson
LICENSING EVALUATOR SIGNATURE:	DATE: 03/11/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/11/2026

LIC9099 (FAS) - (06/04)

Page: 2 of 3

Control Number 15-AS-20251212084904

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: NICOLE HOME	FACILITY NUMBER: 079201128
	VISIT DATE: 03/11/2026

NARRATIVE

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Continued from LIC9099C

Allegation: Staff does not ensure resident is provided with personal hygiene assistance
During interviews, S1 stated clients are showered in the morning after breakfast, cleaned up in the middle of day, if needed, and are cleaned up before going to bed at night. S1 also stated, C2 doesn't always want to shower in the morning. S2, S3, S4 stated staff have a daily routine, each staff member is assigned a client, every morning after breakfast all clients are given a shower and changed when needed. During interviews with C1, it was stated that C1 is given a shower every morning, after eating breakfast. C2, stated sometimes doesn't want to shower in the morning.

Based upon the information obtained during investigation. The above allegations are unsubstantiated. A finding that the complaint is UNSUBSTANTIATED means that although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violation occurred.

Exit interview conducted and a copy of report was given to Fernando Fernandez.

SUPERVISORS NAME: Harpreet Humpal
LICENSING EVALUATOR NAME: Tonica Syess-Gibson
LICENSING EVALUATOR SIGNATURE:	DATE: 03/11/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/11/2026

LIC9099 (FAS) - (06/04)

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