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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 345002983
Report Date: 03/12/2025
Date Signed: 03/12/2025 11:47:33 AM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO NORTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
This is an official report of an unannounced visit/investigation of a complaint received in our office on
12/03/2024 and conducted by Evaluator Cassie Yang
COMPLAINT CONTROL NUMBER: 59-AS-20241203135004
FACILITY NAME:LOMOND HOMEFACILITY NUMBER:
345002983
ADMINISTRATOR:SORONGON, ESPERANZAFACILITY TYPE:
734
ADDRESS:4841 LOCH LOMOND DRTELEPHONE:
(650) 580-3896
CITY:CARMICHAELSTATE: CAZIP CODE:
95608
CAPACITY:5CENSUS: 5DATE:
03/12/2025
UNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Edna LegasTIME COMPLETED:
11:45 AM
ALLEGATION(S):
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Staff verbally abuse clients in care.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Cassie Yang arrived unannounced at the facility to deliver the finding. LPA met with facility registered nurse and explained the purpose of the visit.

Allegation: Staff verbally abuse clients in care.
Throughout the course of this investigation, LPA conducted extensive interviews. Based on interview conducted regarding S1 verbally abuse clients, S2 revealed S2 has witnessed S1 telling C1 comments such as "where is your brain?". S2 stated C1 has limited verbal communication. Based on interview conducted with S3 revealed S3 has witnessed S1 making inappropriate comments to C1 such as "you have a big mouth, but no brain". Based on interview conducted with C2 revealed S1 has told C2 to shut up when C2 scream and/or yell. Therefore, the allegation is substantiated.

Due to this information obtained, the Department finds the allegations to be SUBSTANTIATED - A finding that the complaint is Substantiated means that the allegation is valid because the preponderance of the evidence standard has been met. Deficiencies cited on the attached LIC 9099-D.

An exit interview was conducted, a copy of the report and appeal rights provided.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Anthony Perez
LICENSING EVALUATOR NAME: Cassie Yang
LICENSING EVALUATOR SIGNATURE:

DATE: 03/12/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/12/2025
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 59-AS-20241203135004
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO NORTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

FACILITY NAME: LOMOND HOME
FACILITY NUMBER: 345002983
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/12/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
04/11/2025
Section Cited
CCR
80072(a)(1)
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80072 Personal Rights (a) ... each client shall have personal rights which include, but are not limited to, the following: (1) To be accorded dignity in his/her personal relationships with staff and other persons.

This requirement is not met as evidenced by:
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Licensee is to conduct a personal rights training for all facility staff. Proof of training material with attendee list is due to LPA by April 11, 2025.
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Based on interviews conducted, Licensee did not comply to the section cited above as S1 was observed to not treat clients in care with dignity and respect which poses a potential health and safety risk for residents 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: Anthony Perez
LICENSING EVALUATOR NAME: Cassie Yang
LICENSING EVALUATOR SIGNATURE:

DATE: 03/12/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/12/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 3