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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 079201246
Report Date: 02/09/2024
Date Signed: 02/12/2024 09:04:47 AM

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
01/24/2024 and conducted by Evaluator Luisa Fontanilla
PUBLIC
COMPLAINT CONTROL NUMBER: 15-AS-20240124094255
FACILITY NAME:CONTRA LOMA HOME LLCFACILITY NUMBER:
079201246
ADMINISTRATOR:KUMAR, HARMESHFACILITY TYPE:
735
ADDRESS:4131 SHELTER COVE COURTTELEPHONE:
(925) 826-6557
CITY:ANTIOCHSTATE: CAZIP CODE:
94531
CAPACITY:6CENSUS: 2DATE:
02/09/2024
UNANNOUNCEDTIME BEGAN:
10:20 AM
MET WITH:Lu LiTIME COMPLETED:
12:40 PM
ALLEGATION(S):
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RSO who is not a client allegedly resides, is present and/or has contact that may pose a risk to the health & safety of clients in care.
INVESTIGATION FINDINGS:
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 On 02/9/2024 at around 10:25am, Licensing Program Analyst (LPA) L. Fontanilla conducted an unannounced visit to deliver the finding of the allegation. LPA was met by one female renter who states Licensee has not been at the facility for 8 days. LPA contacted the Licensee on the phone and informed her about LPA visit. Licensee arrived at around 10:54 am.

Based on evidence obtained during the course of this investigation on 1/25/2024, the Department has substantiated the allegation that an individual who has been convicted of a crime for which registration as a Registered Sex Offender (RSO) is required, is residing at the facility or has presence/contact that may pose a risk to the health and safety of the client(s) in care at a facility licensed by the department. This is a factual determination based on all of the facts and circumstances of the case.

Deficiency is cited per Title 22 Regulations (refer to Lic 9099D). Exit interview is conducted, Appeal Rights and a copy of this report was provided to Licensee.

Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Yvonne Flores-Larios
LICENSING EVALUATOR NAME: Luisa Fontanilla
LICENSING EVALUATOR SIGNATURE:

DATE: 02/09/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/09/2024
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
Citations on this Visit Report are Under Appeal!

Control Number 15-AS-20240124094255
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: CONTRA LOMA HOME LLC
FACILITY NUMBER: 079201246
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/09/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Under Appeal
Type A
02/09/2024
Section Cited
CCR
80019(a)
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Section 80019 (a) Criminal Record Clearance
(a) The Department shall conduct a criminal record review of all individuals specified in Health and Safety Code Section 1522(b) and shall have the authority to approve or deny a facility license, or employment, residence, or presence in the facility, based upon the results of such review.


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The Administrator states the RSO has been removed from the facility during the time the IB investigators were present at the facility but does not remember exact date. The Administrator added she has changed the locks of the house. This deficiency is cleared.
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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: Luisa Fontanilla
LICENSING EVALUATOR SIGNATURE:

DATE: 02/09/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/09/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 2