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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 079201147
Report Date: 02/06/2025
Date Signed: 02/06/2025 11:41:55 AM

Substantiated


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
06/25/2024 and conducted by Evaluator Alona Gomez
COMPLAINT CONTROL NUMBER: 15-AS-20240625104438
FACILITY NAME:ALAMO CARE HOMEFACILITY NUMBER:
079201147
ADMINISTRATOR:NAGY, ARPADFACILITY TYPE:
740
ADDRESS:2795 MIRANDA AVE.TELEPHONE:
(925) 413-3578
CITY:ALAMOSTATE: CAZIP CODE:
94507
CAPACITY:6CENSUS: 7DATE:
02/06/2025
UNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Administrator, Levente NagyTIME COMPLETED:
12:00 PM
ALLEGATION(S):
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Licensee did not issue resident’s authorized representative a timely refund for the correct amount.
Staff did not dispense medication to resident as prescribed.
INVESTIGATION FINDINGS:
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On 2/06/2025 at 10:00 AM, Licensing Program Analyst (LPA) A. Gomez arrived unannounced to deliver findings for the above allegations. LPA met with Licensee, Levante Nagy and explained the purpose of the visit.

During course of the investigation, LPA conducted interviews with facility staff, and witnesses. Documents including but not limited to R1’s admission agreement, physician’s report, care plan, medication log, refund records were reviewed. LPA visited the facility on 7/5/2024, 10/25/2024, and 12/27/2024.

Report Continues on LIC9099-C
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Yvonne Flores-Larios
LICENSING EVALUATOR NAME: Alona Gomez
LICENSING EVALUATOR SIGNATURE:

DATE: 02/06/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/06/2025
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 5
Control Number 15-AS-20240625104438
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: ALAMO CARE HOME
FACILITY NUMBER: 079201147
VISIT DATE: 02/06/2025
NARRATIVE
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On 10/25/2024 LPA interviewed S1 who stated that they have given Liquid morphine to residents before including R1. S1 is not a medical professional. On 12/27/2024 LPA interviewed the Licensee who stated that they have given Liquid morphine to residents before including R1. Licensee is not a medical professional. On 12/27/2024 LPA also had a discussion with the Licensee regarding refunds and they admitted that they did not give the complete refund as required to R1s POA because they were unaware of the amount they were supposed to give. Based on interviews and record reviews the allegations “Licensee did not issue resident’s authorized representative a timely refund for the correct amount.” and “Staff did not dispense medication to resident as prescribed.” Are substantiated.

Based on LPAs observations and interviews which were conducted and record reviews, the preponderance of evidence standard has been met, therefore the above allegations are found to be SUBSTANTIATED. California Code of Regulations (Title 22, Division 6, Chapter 8), are being cited on the attached LIC 9099D

Exit interview conducted and a copy of report provided.
SUPERVISORS NAME: Yvonne Flores-Larios
LICENSING EVALUATOR NAME: Alona Gomez
LICENSING EVALUATOR SIGNATURE:

DATE: 02/06/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/06/2025
LIC9099 (FAS) - (06/04)
Page: 4 of 5
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
06/25/2024 and conducted by Evaluator Alona Gomez
COMPLAINT CONTROL NUMBER: 15-AS-20240625104438

FACILITY NAME:ALAMO CARE HOMEFACILITY NUMBER:
079201147
ADMINISTRATOR:NAGY, ARPADFACILITY TYPE:
740
ADDRESS:2795 MIRANDA AVE.TELEPHONE:
(925) 413-3578
CITY:ALAMOSTATE: CAZIP CODE:
94507
CAPACITY:6CENSUS: 7DATE:
02/06/2025
UNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Administrator, Levente NagyTIME COMPLETED:
12:00 PM
ALLEGATION(S):
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9
Staff did not provide residents with adequate food service.
INVESTIGATION FINDINGS:
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On 02/06/2025 at 10:00 AM, Licensing Program Analyst (LPA) A. Gomez arrived unannounced to deliver findings for the above allegations. LPA met with Licensee, Levante Nagy and explained the purpose of the visit.

During course of the investigation, LPA conducted interviews with facility staff, and witnesses. Documents including but not limited to R1’s admission agreement, physician’s report, care plan, medication log, refund records were reviewed. LPA visited the facility on 7/5/2024, 10/25/2024, and 12/27/2024.

Report Continues on LIC9099-C
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Yvonne Flores-Larios
LICENSING EVALUATOR NAME: Alona Gomez
LICENSING EVALUATOR SIGNATURE:

DATE: 02/06/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/06/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 2 of 5
Control Number 15-AS-20240625104438
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: ALAMO CARE HOME
FACILITY NUMBER: 079201147
VISIT DATE: 02/06/2025
NARRATIVE
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On all visits LPA observed that the facility was fully stocked with good quality food and of appropriate quantities. LPA was unable to get proof of inadequate food service from any witnesses. Therefore the allegation “Staff did not provide residents with adequate food service.” Is unsubstantiated.

Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is UNSUBSTANTIATED.

Exit interview conducted and a copy of report provided.
SUPERVISORS NAME: Yvonne Flores-Larios
LICENSING EVALUATOR NAME: Alona Gomez
LICENSING EVALUATOR SIGNATURE:

DATE: 02/06/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/06/2025
LIC9099 (FAS) - (06/04)
Page: 3 of 5
Control Number 15-AS-20240625104438
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: ALAMO CARE HOME
FACILITY NUMBER: 079201147
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/06/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
02/06/2025
Section Cited
CCR
87633(b)(4)(B)(b)
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(b)A current and complete hospice care plan...: (4)A description...facility. B) The plan shall specify... the licensed health care professional...will control...administration of all controlled drugs...

This requirement is not met as evidence by:
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Administrator has reviewed the regulation and confirms they understand the regulation. POC clear.
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Based on interviews with staff the facility did not comply with the above regulation by administering morphine to R1 which posed an immediate safety risk to residents in care
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Type B
02/06/2025
Section Cited
HSC
1569.652(c)
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(c) A refund of any fees paid in advance...shall be issued...within 15 days after the personal property is removed.

This requirement is not met as evidence by:
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Administrator has reviewed the regulation and confirms they understand the regulation. POC clear.
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Based on interviews with staff the facility did not comply with the above regulation by not refunding the correct amount to R1's responsible party after R1 deceased which posed a potential personal rights violation.
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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: Yvonne Flores-Larios
LICENSING EVALUATOR NAME: Alona Gomez
LICENSING EVALUATOR SIGNATURE:

DATE: 02/06/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/06/2025
LIC9099 (FAS) - (06/04)
Page: 5 of 5