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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 079201147
Report Date: 02/23/2023
Date Signed: 02/23/2023 01:41:26 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
02/21/2023 and conducted by Evaluator Lizette Francisco
PUBLIC
COMPLAINT CONTROL NUMBER: 15-AS-20230221133515
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: 4DATE:
02/23/2023
UNANNOUNCEDTIME BEGAN:
01:20 PM
MET WITH:Arpad Nagy, AdministratorTIME COMPLETED:
01:50 PM
ALLEGATION(S):
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Chemicals are accessible to residents in care.
INVESTIGATION FINDINGS:
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On 2/23/2023 at 1:20 PM, Licensing Program Analyst (LPA) L. Francisco arrived unannounced to conduct an intial 10-day complaint investigation for the above allegation. LPA met with Administrator, Arpad Nagy and explained the purpose of the visit.

During the 10-day complaint investigation, LPA obtained information and toured facility. It was alleged chemicals are accessible to residents in care. Based on photos obtained from another agency, unlocked cleaning supplies in the laundry room were accessible to residents.

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. Appeal rights and a copy of this report provided to Administrator.
Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Harpreet HumpalTELEPHONE: (510) 285-3928
LICENSING EVALUATOR NAME: Lizette FranciscoTELEPHONE: (510) 286-4201
LICENSING EVALUATOR SIGNATURE:

DATE: 02/23/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/23/2023
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 2
Control Number 15-AS-20230221133515
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: ALAMO CARE HOME
FACILITY NUMBER: 079201147
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/23/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
02/24/2023
Section Cited
CCR
87705(f)(2)
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87705(f)(1) CARE OF PERSONS WITH DEMENTIA
(f) The following shall be stored inaccessible to residents with dementia:
(2) Over-the-counter medication..and toxic substances such as..cleaning supplies and disinfectants.
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By POC date, Administrator agrees to review regulation and conduct an in-service training with staff, and submit a copy of training agenda with signatures to CCLD.
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This requirement is not met as evidenced by: Based on record review, Licensee did not comply with the regulation cited above by having cleaning supplies in laundry room unlocked and accessible which poses an immediate 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.
SUPERVISOR'S NAME: Harpreet HumpalTELEPHONE: (510) 285-3928
LICENSING EVALUATOR NAME: Lizette FranciscoTELEPHONE: (510) 286-4201
LICENSING EVALUATOR SIGNATURE:

DATE: 02/23/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/23/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 2